Letter from the District Health Director Volutpat
mos
at
neque
nulla
lobortis
lobortis
lobortis
lobortis
lobortis
d conventio, torqueo, acsi roto modo. Feugait in obruo quae ingenium tristique elit vel natu meus. Molior t
o
r
q
u
e
o
c
a
p
i
o
v
e
l
i
t
loquor aptent ut lorem erat feugiat pneum commodo vel obruo mara genitus. Suscipit, vicis praesent erat feugait epulae, validus indoles duis enim consequat genitus at. Sed, conventio, aliquip accumsan adipiscing augue blandit minim abbas oppeto commoveo. Enim neo velit adsum odio, multo, in commoveo quibus premo tamen erat huic. Occuro uxor dolore, ut at praemitto opto si sudo, opes feugiat iriure validus. Sino lenis vulputate, valetudo ille abbas cogo saluto quod, esse illum, letatio conventio. Letalis nibh iustum transverbero bene, erat vulputate enim
Cobb & Douglas Public Health www.cobbanddouglaspublichealth.org
TABLE OF CONTENTS Highlights................................................. 3 Profile of Our County ............................... 8 Geography of Cobb County ................................... 10 Health.................................................................. 11 Population ............................................................ 12 Age Distribution.................................................... 14 Households .......................................................... 15 Economics............................................................ 17 Unemployment ..................................................... 18 Poverty ................................................................ 19 Homelessness ...................................................... 20 Education ............................................................. 21
Access to Healthcare ................................ 23 Access to Primary Care ......................................... 25 Access to Dental Care ........................................... 26 Insurance Coverage .............................................. 27
Leading Causes ........................................ 30 Leading Causes of Mortality (Death) ...................... 32 Leading Causes of Hospitalization .......................... 33 Leading Causes of Premature Deaths ..................... 33 Age Adjusted Mortality Rates................................. 34
Chronic Disease........................................ 35 Cardiovascular Disease ......................................... 37 Cancer ................................................................. 42 Breast Cancer ....................................................... 44 Asthma ................................................................ 48 Diabetes .............................................................. 52 Chronic Obstructive Pulmonary Disease (COPD) ..... 56 Alcohol Use .......................................................... 57 Smoking .............................................................. 59 Overweight/Obesity .............................................. 60
Infectious Disease ................................... 64 Sexually Transmitted Diseases .............................. 66 Human Immunodeficiency Virus (HIV) ................... 70 Tuberculosis ......................................................... 74 Hepatitis .............................................................. 76 Seasonal Influenza ............................................... 77 H1N1 Influenza .................................................... 78
Pneumonia ........................................................... 79 Vaccine Preventable Illness .................................... 79 Invasive Bacterial Disease ..................................... 81 Gastrointestinal Illness .......................................... 82 Foodborne Outbreaks ............................................ 83
Maternal & Child Health ...........................86 Pregnancy ............................................................ 88 Prenatal Care ........................................................ 90 Abortions .............................................................. 91 Infant Mortality ..................................................... 92 Breastfeeding ....................................................... 96 Childhood Morbidity .............................................. 96 Childhood Immunization ........................................ 97 Youth Risk Behaviors ............................................. 97 Youth Obesity ....................................................... 98 Alcohol Use........................................................... 102 Youth Smoking ..................................................... 103 Behavioral Health .....................................105 Mental Disorders ................................................... 108 Mood Disorders ..................................................... 109 Psychotic Disorders ............................................... 110 Mental Disorders Among Children & Adolescents ..... 111 Addictive Disease .................................................. 112 Community Safety ....................................114 Crime ................................................................... 116 Family Violence ..................................................... 118 Injuries ................................................................ 119 Motor Vehicle Crashes ........................................... 119 Suicide ................................................................. 124 Emergency Preparedness and Response ................. 125 Environmental Health ...............................126 Air Quality ............................................................ 129 Water Quality ....................................................... 130 Hazardous Waste Sites .......................................... 131 Rabies .................................................................. 132 Why Is Rabies Important? ..................................... 133 Improving Our Community .......................135
Appendix .................................................... 131 Tables & Figures ................................................... 132 Resources........................................................................ 135 Programs & Services ..................................................... 136
II
HIGHLIGHTS Highlights
Cobb and Douglas Public Health (CDPH) staff designed How Healthy Are We? to provide a general assessment of Cobb County residents’ health. We partnered with the Cobb County Community Services Board to provide the information for the section on Behavioral Health. The contents of this report represent information we track, trend and use to assess our community’s current and future health needs. We hope this report provides you with valuable knowledge regarding the health of Cobb County – the community in which we live, work and play. We all have a responsibility and must work together to make ourselves, our families, our neighborhoods, and our county healthy. Below are highlights from the report.
Population
The population in Cobb County continues to grow and has a large percent of youth and an increasing percent of minority populations. Over one-fourth of the population is under the age of 19. Minority populations grew 26% over the past 5 years. There is a greater percentage of Hispanics in Cobb County compared to Georgia. Almost 5% of Hispanic households are linguistically isolated and do not have a household member who speaks English well. These language differences often make health care communications difficult.
Access to Care
Residents must have access to healthcare (facilities and providers) in order to be healthy. Primary care physicians (family practitioners, internists and pediatricians) make up 34% of Cobb County physicians. These physicians provide the gateway to healthcare, including specialty care. The current economy causes job and insurance loss, resulting in residents not receiving regular dental care. Regular dental care is vital to good health. The percentage of uninsured individuals in Cobb County is higher than in Georgia; however Cobb County is ranked as the 4th highest county in the state for household income. Cobb County residents made up only 3.9% of the Georgia Medicaid members in 2008; however the average annual Medicaid payment per Cobb County member was higher than the payment per Georgia member (2008).
Leading Causes of Illness and Death
There are specific leading causes of illness and death in the county. The top 5 leading causes of mortality (death) for Cobb County are consistent with the United States’ top 5 leading causes of mortality. Heart disease, cancer and stoke are the leading causes of illness (morbidity), death (mortality) and premature death in Cobb County. The age-adjusted mortality rate for Cobb County is lower than Georgia’s. Pregnancy and normal delivery causes a high number of hospitalizations, indicating a growing county. Preventable deaths, including accidents, homicide and suicide, are the leading causes of premature deaths (death prior to age 75).
3
Cobb County Health Status Report, 2010
HIGHLIGHTS Chronic Diseases
Chronic diseases (diseases lasting longer than 6 months) such as diabetes and asthma continue to cause a high number of illnesses and deaths in the county; they also cause high healthcare costs. Cancer is the leading cause of premature death (<75 years of age) in Cobb County, followed by Heart Disease. Lung cancer is the leading cause of cancer mortality for both men and women in Cobb County. The mortality rate due to breast cancer is slightly higher in Cobb County compared to Georgia and the United States. The mortality rate in Cobb County due to Alcoholic Liver Disease was slightly higher in Cobb County than in Georgia. Additionally, based on self-reported results, Cobb County adults report higher percentages of “heavy drinkers” and “binge drinkers” than Georgia. In 2008, a higher percentage of adult residents reported being “overweight” in Cobb County compared with Georgia; however a lower percentage of adults reported being “obese” as compared with Georgia.
Infectious Diseases
Infectious diseases can spread quickly through populations, causing high numbers of illness, death and disability. Sexually transmitted diseases (STDs) such as gonorrhea, syphilis, AIDS and hepatitis B are prevalent in Cobb County and in Georgia. Georgia ranks 3rd highest in the U.S. for rates of primary and secondary syphilis; and Cobb County ranks 7th highest out of Georgia’s 159 counties for the rate of syphilis (cases per 100,000 population). The number of Tuberculosis (TB) cases in Cobb County decreased by 30.8% from 2008-2009; this was also seen throughout the state of Georgia. Vaccine-preventable diseases are still occurring in Cobb County; and childhood immunization rates are slightly lower in the County than in Georgia. The CDC expects the H1N1 flu virus to return in the 2010-2011 flu season, along with seasonal flu viruses. Unlike seasonal flu, H1N1 primarily affected persons 49 and under in 2009. This year’s seasonal flu vaccine will protect against H1N1 and 2 other flu viruses.
Maternal and Child Health
One can assess the overall health status of the population by analyzing the health of mothers and their babies. Overall pregnancy rates are higher in Cobb County than in Georgia. Teen pregnancy rates have increased overall in 2006 and 2007 in both Georgia and Cobb County. The Hispanic population has the highest pregnancy rates both overall and for teens (15-19 years) in the County. Hispanics, compared to all populations, have the highest rate of inadequate prenatal care. Cobb County ranks poorly in the percentage of infants who are born with low birth weight (LBW); this is highest in the black population. LBW can cause serious medical problems in the infants.
4
HIGHLIGHTS Maternal and Child Health
Cobb County’s youth play a key role in determining the County’s future health status. In the 2008 – 2009 school year, 9.6% of 12th grade students in Marietta City Schools and 15.6 % in Cobb County Schools reported using tobacco in the last 30 days. In the 2008 – 2009 school year, 5.2% of 12th grade students in Marietta City Schools and 8.4 % in Cobb County Schools reported binge alcohol drinking in the last 30 days. Obesity in children and adolescents continues to be a major public health concern in the United States, Georgia and the County. In 2009, 12.4% of Georgia’s youth were reported as being obese compared to 12.0% in the United States.
Community Safety
Residents must feel safe in their community in order to enjoy a good quality of life. The violent crime rate is lower in Cobb County than in Georgia. From 2004-2008, larceny was the most frequently committed crime in Cobb County. Injuries due to external causes (such as motor vehicle crashes, homicide, falls and suicide) accounted for 25.7% of all Cobb County Emergency Department visits; falls are the number one cause of injury related Emergency Department visits. Motor vehicle crashes are a leading cause of hospitalization and death in the county. In 2008, Cobb County ranked 2nd highest out of the 159 counties in Georgia for motor vehicle crash fatalities.
Behavioral Health
Behavioral health refers to how a person’s mental well-being affects his or her actions and ability to function. It is estimated that 26.3% of adults suffer from a mental disorder in a given year in Cobb County. Estimates suggest that approximately 6% of adults suffer from a serious mental illness such as major depression, bipolar disorder, or schizophrenia in Cobb County.
Environmental Health
The environment plays a key role in health status. Cobb County has an award winning water system. The system reports that in 2009, drinking water met or exceeded all safety and quality standards set by the State of Georgia and the Environmental Protection Agency. In 2009, Metropolitan Atlanta (including Cobb County) air quality measured in the unhealthy range 16 out of the 340 days measured. In 2009, 27 hazardous sites were identified in Cobb County. In 2009, the greatest numbers of positive rabies tests were for raccoons.
5
Cobb County Health Status Report, 2010
PROFILE OF OUR COUNTY GEOGRAPHY OF COBB COUNTY Cobb County is located north of Atlanta along the scenic Chattahoochee River. It is bordered on the northwest by Lake Allatoona and its southernmost boundary lies south of Interstate 20. Marietta, the seat of Cobb County government, lies 20 miles northwest of downtown Atlanta. Cobb Countyâ&#x20AC;&#x2122;s 340 square miles include the municipalities of Marietta, Austell, Powder Springs, Smyrna, Acworth, Kennesaw, and suburban areas in unincorporated Cobb County.
8
PROFILE OF OUR COUNTY HEALTH STATUS Health is defined by the World Health Organization (WHO) as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. There are multiple standards and measurements that help to categorize the health status of both an individual and a community. Figure 2-1 displays the reported health status of adult residents in Cobb County when asked, “How is your general health?”
Figure 2-1: General Health of Cobb County Residents, 2002, 2006-2008 45.0
41.5
40.0 35.0
Percent
30.0
34.2 32.8
25.0 20.0
23.2
36.7
35.7 28.7 26.6
27.1 23.7
27.6 25.8
Excellent Very Good Good
In 2008, the majority of Cobb County residents reported their overall health as “excellent” or “very good.”
Fair
15.0 7.8
10.0
6.6
5.5
4.4
3.2
3.2
3.3
2006
2007
2008
Poor
5.0 0.0
2.0 2002
9
Cobb County Health Status Report, 2010
PROFILE OF OUR COUNTY POPULATION Demographic factors including age, race, ethnicity, sex, education and income are directly and indirectly related to health status and health outcomes.
Cobb County population increased by 14.9% between 2000-2008.
A 12.7% increase in Cobb’s population is projected from 2008 to 2015.
Cobb ranks 4 highest in population out of the 159 counties in Georgia.
The
th
minority (non-white) population in Cobb has grown by 26% over the past 5 years.
Blacks made up 23.3% of the Cobb population in 2008.
Hispanics comprised 11.7% of Cobb’s population, In 2008,
compared to 8% in Georgia and 15.1% in the U.S.
Hispanic population in Cobb grew 33.8% from 2003-2008.
The
Foreign born residents made up approximately 15% of Cobb County residents in 2008.
Of the foreign born population in Cobb County, 53.3% were from Latin
America; the second most populous group was from Asia which made up 23.5% of the foreign born population in 2008.
10
PROFILE OF OUR COUNTY HISPANIC POPULATION The Hispanic population continues to be one of the fastest growing populations in the United States. From 2003-2008 the Hispanic population in Cobb grew 33.8%.
LANGUAGE BARRIERS Language barriers and miscommunication between patients and healthcare workers can result in tragic medical outcomes. Patients who meet such obstacles are less likely to have a regular source of medical care or receive preventative services. Additionally, they are less likely to follow medication instructions as directed. Table 2-1: Language Spoken at Home by Household Cobb County, 2006-2008 Language Households Percent English
207,005
81.8%
Spanish
22,224
8.8%
Other Indo-European languages
13,866
5.5%
Asian and Pacific Island languages
6,252
2.5%
Other
3,801
1.5%
Linguistically Isolated (>14 years who do not speak English well)
10,548
4.6%
11
In Cobb County, 18.2% of residents speak a language other than English at home.
Cobb County Health Status Report, 2010
PROFILE OF OUR COUNTY AGE DISTRIBUTION The size, age and gender composition of the population can help determine the healthcare needs of a community. The population pyramid (Figure 2-4) illustrates the age and sex distribution of Cobb County.
The male to female population in Cobb County is almost equal,
with
slightly more females, 50.4% compared to males, 49.6%.
The
median age in Cobb County is 36.3; males - 35.0 and
females - 37.5.
The
40 - 49 year old age group makes up the
largest percentage of all age groups in Cobb County, representing 16.6% of the population. 1/4th of the population in Cobb County (28.6%) is under the age of 19.
Over
The Atlanta Regional Commission estimates the
55+ population in Cobb County will
grow by 85% between 2000 and 2030.
12
PROFILE OF OUR COUNTY HOUSEHOLDS Household characteristics directly impact health status. Single parent and grandparent raising grandchildren families often experience poorer physical and mental health. Table 2-2 shows select household characteristics for Cobb County (2006-2008).
Table 2-2: Household Profile Cobb County, 2006-2008 253,148
Total Households
51.3%
Married Couple Family Households
32.1%
Nonfamily Households Female Householder; no husband present
4.6%
Male Householder; no wife present Households with Children (< 18 years old) Married Couple with Children Female Householder with Children Male Householder with Children Nonfamily Household with Children
13
12.0%
* Nonfamily households include individuals who are living alone (66,270 72.7% households) and individuals who are not related (14,977 house20.4% holds).
71.3%
6.2% 0.7%
Cobb County Health Status Report, 2010
PROFILE OF OUR COUNTY Over the past twenty years, the number of grandparents parenting their grandchildren has increased in the United States - especially in the southern states. Grandchildren are placed with grandparents for a number of reasons including parental substance abuse, child abuse and neglect, psychiatric disorders, incarceration, and homicide resulting from domestic violence events.
14
PROFILE OF OUR COUNTY ECONOMICS INCOME Numerous studies show a link between income and health. In general, the higher the income the healthier a person is likely to be.
Household Income Facts
The Georgia County Guide ranks Cobb County number
4th highest of all
159 counties in the state of Georgia for household income.
The median household income for 2008 in Cobb County was
$67,877 and per capita income was $33,793.
From 2007-2008, national median household income levels fell by
3.6% from $52,163 to $50,303.
15
Cobb County Health Status Report, 2010
PROFILE OF OUR COUNTY UNEMPLOYMENT Unemployment rates have increased throughout the United States, Georgia and Cobb County since 2007. Unemployment negatively affects access to health care due to potential loss of health insurance coverage and the inability to pay for healthcare services. Unemployment Facts ď&#x201A;ˇ
The Atlanta Regional Commission estimates from 2006-2009 Cobb County lost
10,019
jobs, a net decrease of
3.1%. ď&#x201A;ˇ
Unemployment rates continued to increase throughout 2009; Cobb County remained under the Georgia rate at
9.3%. Unemployment data in the United States is collected through a monthly sample survey called the Current Population Survey (CPS). An employed person is defined as a person who did any work for pay during the reference week or a person who worked over 15 hours not for pay in a family-owned business, and all persons who are temporally absent from jobs regardless of pay.
16
PROFILE OF OUR COUNTY POVERTY Individuals in poverty have poorer health outcomes. Children and adults with incomes at or below the poverty line often face issues including inadequate nutrition, substandard housing, environmental hazards, unhealthy lifestyles, and decreased access to and use of health care services. Poverty thresholds are set based on size and age of family members. (For more information on poverty thresholds go to http://www.census.gov/hhes/www/poverty/methods/measure.html). Table 2-3: Poverty, 2006-2008 Location Individuals in Poverty Cobb 62,804 Georgia 1,339,822 United States 38,573,393
Percent in Poverty 9.2% 14.5% 13.2%
Sources: US Census Bureau, American Community Survey 2006-2008. The Georgia County Guide (28th ed.), CDC National Center for Health Statistics, Health, United States, 2008 Special Feature on Health of
The Georgia County Guide ranks Cobb County
9th lowest out of the 159 counties in the favorably,
Young Adults
state for poverty levels based on 2008 estimates.
Nonfamily households made up the largest percentage of households in poverty at
48.6%.
The largest percent of family households in poverty are female households with no husband present,
28.0%.
17
Cobb County Health Status Report, 2010
PROFILE OF OUR COUNTY HOMELESSNESS The homeless population lives in extreme poverty and often faces other personal and health problems including domestic violence, criminal background, physical disability, chronic disease, mental health condition, substance abuse, developmental disability, and brain injury. It is estimated that approximately 2.3% of Georgiaâ&#x20AC;&#x2122;s homeless population resides in Cobb County. The federal definition for an individual who is homeless includes: 1. an individual who does not have a fixed, regular and adequate nighttime residence; and 2. an individual who has a primary nighttime residence that is A. a shelter designed to provide temporary accommodations (including welfare hotels, congregate shelters, b. and transitional housing for the mentally ill) an institution that provides temporary residence for individuals intended to be institutionalized C. a public or private place not designed for or ordinarily used as regular sleeping accommodations for human beings.
Table 2-4: Homeless Population and Shelter Beds, 2009 Location Sheltered Unsheltered Total Beds for Victims Homeless Homeless of Domestic Persons Persons Violence Cobb 368 126 494 44 Georgia 8,994 12,101 21,095 1,308
Beds (Excluding Domestic Violence) 401 8,831
Total Beds 445 10,139
Note: Based on 2008 and 2009 Continuum of Care Housing Inventories and 2009 Homeless Count and Predictive Model.
18
PROFILE OF OUR COUNTY EDUCATION Education can influence health in many ways. The years of schooling a person has is linked with health knowledge and behaviors, employment and income, and social and psychological factors. Individuals with higher education are likely to have a longer life span, to have better health outcomes and to practice healthy behaviors. These include regular exercise, not smoking, and obtaining timely health care check-ups and screenings. Babies of well-educated mothers are less likely to die before their first birthdays and children of more-educated parents are more likely to achieve higher education and experience better health.
When compared to high school graduates,
are more likely to:
dropouts
be unhealthy be unemployed live below the poverty line receive governmental assistance be incarcerated be divorced be a single parent who has a child who repeats the dropout cycle
These factors affect not only the individual but the entire community.
19
Cobb County Health Status Report, 2010
PROFILE OF OUR COUNTY
High School Graduation Facts
The 2006-07 graduation rate in the U.S. was
73.9%.
Cobb County and Marietta City Schools remain
above both the US and
Georgia rates; however, Georgia
falls below the U.S. rate.
20
ACCESS TO HEALTHCARE Access to care is affected by a number of different factors including the number of healthcare facilities and providers in an area and the availability and affordability of healthcare.
ACCESS TO PRIMARY CARE In 2008, more Georgia physicians provided specialty care than primary care. The Georgia County Guide 2010 reports that 34% of Cobb County physicians are considered primary care physicians (family practice, internal medicine and pediatrics), an adequate percentage for the county. The Georgia Health Disparities Report 2008 compares 32 counties in Georgia, including Cobb, on a number of important health issues including access to care. Letter grades were assigned to the counties based on various criteria. Cobb County received the following letter grades.
Letter Grade
B
B
C
23
Access to Care Category Access to Primary Care Providers
Primary Care Safety Net
Health Professional Diversity
Comments The Report designates Cobb as a “partialcounty health professional shortage area.” Eleven of the 32 counties received an A. Cobb County residents have access to a federally qualified community health center, which provides primary care to residents. Measure of the black and Latino physicians per 100,000 black and Latino population. The Cobb rate is 74.0 minority physicians per 100,000 population. Even though Cobb’s rate is higher than many of the 32 counties studied, it is still much lower than the rate for white physicians. Often residents from minority races prefer to see physicians of their own race.
Cobb County Health Status Report, 2010
ACCESS TO HEALTHCARE ACCESS TO DENTAL CARE
Did you know…
Regular oral healthcare improves overall health. It also leads to the early treatment, diagnosis and prevention of oral diseases including oral cancer. Routine cleanings are recommended every 6 months for adults and children, and have been shown to decrease incidence of plaque and gingivitis. Dental infections can rapidly spread to other parts of the body causing serious infections and illness.
CDPH provides dental services for children ages 2 -20 as long as they are still in High School. These services include dental screenings, composite fillings, sealants, cleanings, fluoride treatments, stainless steel crowns, pulpotomies, and extractions. We also provide extractions for adults during limited hours. Acceptable payment methods are Peachcare, Medicaid and cash.
According to the American Dental Hygienists’ Association, 40% of Americans are not receiving the recommended dental care. A significant factor inhibiting access to care is the ability to pay for dental services. Another important inhibiting factor is the lack of sufficient numbers of dentists practicing in rural and inner-city areas. Fortunately, according to the Georgia Health Disparities Report 2008, Cobb County is not a Dental Health Professional Shortage Area. Table 3-1: Percent of Adult Residents who Visited a Dentist or a Dental Clinic within the Past Year 2002, 2006,2008 Location Cobb Georgia
2002 77.1 % 67.0 %
2006 74.9 % 70.7 %
Call us at 770-514-2372.
2008 77.8 % 71.8 %
Of Cobb County adult residents who took the Did survey, 77.8% said that you know… they had visited the dentist or dental clinic in CDPH the provides past year. This is dental services for children ages 2 compared to 71.8% in Georgia. Percentages 20 have not increased since as long as they are still in High School. These services include dental screenings, composite 2002 and actually decreased in 2006 from 2002. fillings, sealants, cleanings, fluoride treatments,
The percentage from the 2008 survey is expected to decrease in 2010 during limited hours. Acceptable payment methods are Peachcare, Medicaid and cash. due to the poor economy and unemployment rates.
stainless steel crowns, pulpotomies, and extractions. We also provide extractions for adults
Call us at 770-514-2372.
HEALTHCARE FACILITIES Residents must have access to healthcare providers and facilities. Table 6 shows the number of facilities available in Cobb County. Table 3-2 : Healthcare Facilities Cobb County, 2008 Hospitals Hospital Beds Nursing Homes 3
1218
14
Nursing Home Beds 1741
Trauma Centers 0*
*WellStar Kennestone Hospital applied for trauma center designation in 2010. The Metropolitan Atlanta area has three adult and two pediatric trauma centers.
24
ACCESS TO HEALTHCARE INSURANCE COVERAGE Health insurance coverage has a profound effect on access to care. Those without health insurance are less likely to have regular medical care and are more likely to go withUninsured Facts out care. In Georgia, Medicaid and PeachCare are available to provide health insurance coverage for children and adults who are low income Cobb County has an uninsured or disabled. Medicare is available to seniors over age 65. Table 7 population of 15.4% of the shows the percentage of uninsured population in Cobb County. total county population. The largest percentage of uninsured population falls in the 18 – 64 age group. Persons included in this group Table 3-3: Uninsured Residents Cobb County, 2008 make too much money to Percent of Cobb County Number qualify for Medicaid but often Population not enough to pay for health Uninsured 107,019 15.4% care. Population The Georgia Health Disparities Under 18 years 18,740 2.7% Report 2008 gave Cobb 18 to 64 years 87,308 12.6% County a grade of C on the 65 years or over 971 0.1% uninsured as % of total Source: U.S. Census Bureau, 2010. population. The median percentage for the 32 Georgia counties in the Report was 14.8%.
PAYOR SOURCES MEDICAID The Medicaid program in Georgia provides health care for children, pregnant women, and people who are low income, aged, blind and disabled. Table 8 shows the average number of members and payment for Georgia Medicaid in 2008. Averaging membership over the year is necessary because persons enroll in and are dropped from the plan throughout the year. Table 3-4: Medicaid Member Average and Payment, 2008 Average Number of Location Total Net Payment Members Cobb 48,645 $172,101,474 Georgia 1,260,519 $4,515,345,997
Average Payment per Member $5,209 $5,005
Cobb County residents made up 3.9% of the Georgia Medicaid members in 2008. The annual Medicaid payment per Cobb County member was slightly higher than payment per Georgia member. There are approximately equal proportions of white and black populations who are Medicaid members in Cobb County.
25
Cobb County Health Status Report, 2010
ACCESS TO HEALTHCARE Figure 3-1: Medicaid Members by Race & Ethnicity Cobb County, 2008 Black
White
5.1%
Unknown 2.1%
1.5%
Asian
Other
Hispanic
1.2%
45.7% 44.4%
PEACHCARE FOR KIDS™ In 1997, Congress created Title XXI of the Social Security Act to provide health care for the growing number of uninsured children in the United States. This legislation provided states with the opportunity to create programs to increase children’s access to affordable health insurance. In Georgia, this program is PeachCare for Kids™.
26
ACCESS TO HEALTHCARE In 1999, PeachCare for Kids™ began covering comprehensive health care to children through the age of 18 who do not qualify for Medicaid and live in households with incomes at or below 235% of the federal poverty level. This means a family of three can earn $43,029 a year and a family of four can earn $51,818 a year (March 2010 figures). Georgia ranks fourth highest nationally in number of enrolled children. Table 9 shows member average and payment for this program. Averaging membership over the year is necessary because children enroll in and are dropped from the plan throughout the year. Table 3-5: PeachCare for Kids Member Average and Payment, 2008 Average Total Net Payment per Location Number of Payment Member Members Cobb 16,751 $1,667,736 $1,320 Georgia 250,094 $22,624,379 $1,399
Cobb County children made up 6.7% of the member average in 2008. The annual PeachCare payment per Cobb County child was slightly below that for all Georgia children.
Figure 3-3: PeachCare Members by Race and Ethnicity Cobb County, 2008 Black
White
Hispanic
10.3%
Unknown
Asian
PEACH CARE MEMBERS
Other
ARE PRIMARILY BLACK
3.9% 0.3%
(35.6%) FOLLOWED BY WHITE
35.6%
THEN
24.9%
(25%) AND HISPANIC
(24.9%). 25.0%
MEDICARE Medicare is health insurance for people age 65 or older, under 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD). Cobb County had 59,478 residents enrolled in Medicare in 2007-2008 Cobb County Medicare enrollees received $570,421 in payments, which represented 6% of Georgia Medicare payments in 2007 – 2008.
27
Cobb County Health Status Report, 2010
LEADING CAUSES LEADING CAUSES OF MORTALITY (DEATH) The top 5 leading causes of mortality (death) for Cobb County are consistent with the top 5 leading causes of mortality for the U.S. in 2007. From 2003-2007, there were a total of 16,557 deaths in Cobb County, averaging approximately 3,000 deaths per year. During that same period, the overall mortality rate of the white population was 582.7 per 100,000 population. This is higher than the black population which had a mortality rate of 309.8 per 100,000 population.
Table 4-1: Leading Causes of Mortality Diseases of the Heart Cancers Stroke Chronic Lower Respiratory Diseases Accidents Alzheimerâ&#x20AC;&#x2122;s Disease Kidney Diseases Influenza and Pneumonia Diabetes Suicide
2003 133.9 109.1
2004 125.2 118.5
2005 123.1 113.1
2006 109.7 106.4
2007 105.9 113.7
Overall Rate* 119.3 112.2
27.2 28.1 12.7 12.3 9.7 11.4 9.1 9.2
32.4 23.7 17.9 12.5 9.8 9.6 7.8 9.3
31.9 24.3 23.5 13.3 11.0 9.2 10.4 7.1
29.1 24.0 28.3 10.9 9.1 8.1 11.3 9.3
28.5 22.3 23.1 14.5 11.9 9.2 8.1 8.1
29.8 24.4 21.2 12.7 10.3 9.5 9.3 8.6
*Rate = number of deaths per 100,000.
As shown in Figure 4-1, Rates are higher in the black population for heart disease, cancers and stroke.
30
LEADING CAUSES LEADING CAUSES OF HOSPITALIZATION Hospitalization rate is a good health indicator for morbidity (illness or injury) or the amount of disease in a population. In Cobb County, the leading cause of hospitalization was pregnancy and childbirth complications, followed by diseases of the heart.
LEADING CAUSES OF PREMATURE DEATHS Table 4-2: Leading Causes of Premature Death Cobb County, 2003-2007 Cancers Diseases of the Heart Accidents Fetal and Infant Conditions Suicide Homicide Birth Defects Stroke Chronic Lower Respiratory Diseases HIV/AIDS
31
YPLL 38,230 28,867 19,629 12,860 8,862 7,149 5,865 5,075 3,350 3,180
YPLL Rate per 100,000 1183.6 893.7 607.7 398.1 274.4 221.3 181.6 157.1 103.7 98.5
Cobb County Health Status Report, 2010
LEADING CAUSES AGE ADJUSTED MORTALITY RATES Most diseases and health outcomes occur at varying rates dependent upon age groups. For example, chronic conditions like heart disease occur more often among older people. The age distribution of a population often determines the most common health problems in a community. Calculating age adjusted rates allows for comparison across populations with different age distributions.
The age adjusted mortality rate for Cobb County is lower than Georgiaâ&#x20AC;&#x2122;s. Additionally, the black population has a higher rate than that of the white population for both Cobb County and for Georgia. Table 4-3: Age Adjusted Mortality Rate per 100,000 population (2003-2007) Total Population White Black
Cobb County
Georgia
758.4 729.5 782.5
884.4 855.1 1031.0
32
CHRONIC DISEASE According to U.S. National Center for Health Statistics, a chronic disease is a disease lasting 3 or more months. Generally, a chronic disease cannot be prevented by vaccines or cured by medication. Behaviors that put you at risk for developing a chronic disease include tobacco use, lack of physical activity, and poor eating habits.
CARDIOVASCULAR DISEASE Cardiovascular disease (CVD) includes all disease of the heart and blood vessels including ischemic heart disease, stroke, congestive heart failure, high blood pressure and hardening of the arteries (atherosclerosis). Heart disease and stroke are both leading causes of mortality, premature death and illness in the U.S. and in Georgia. In 2007, CVD accounted for 32% of all deaths in Georgia. Conditions including high cholesterol, high blood pressure and diabetes put people at an increased risk of CVD. Additionally, behaviors and lifestyle choices such as tobacco use, diet, physical activity, obesity and alcohol can lead to CVD. A family history of CVD can also make individuals more susceptible.
Figure 5-1: Mortality Rate due to Cardiovascular Diseases, 2003-2007
Age Adjusted Rate per 100,000 population
Cobb 400.0
342.9
326.1
Georgia 307.7
300.0 200.0
295.4
271.0
263.7
282.6
269.0
224.4
209.3
2006
2007
100.0 0.0 2003
2004
2005
The mortality rate for CVD in the white population from 2003-2007 was 249.6 per 100,000 population; slightly lower than the black mortality rate of 288.5.
Heart disease is a general term which includes several different types of heart conditions. The most common is coronary artery disease or ischemic heart disease (IHD). IHD is caused by deposits of fat and plaque on the small blood vessels that supply blood, oxygen and nutrients to the heart (atherosclerosis). IHD can lead to heart attack, angina (chest pain), heart failure and/or irregular heartbeats.
35
Cobb County Health Status Report, 2010
Age Adjusted Rate per 100,000 population
CHRONIC DISEASE
Figure 5-2: Mortality Rates due to Cardiovascular Disease by Type and Race Cobb County, 2003-2007 100
75.5
60
20
IHD which, includes heart attacks, is the leading cause of heart disease deaths in Cobb County and in Georgia.
88.7
80
40
CVD Facts
73.2 49.1 White
23.1 10.5
Black 6.5 9.3
0 High Blood Pressure
Hypertensive Ischemic Heart Heart Disease Disease
Table 5-1: Percent of Adults who report CVD Conditions, Cobb County (Self-Reported) 2007 & 2008 Percent of adults who were ever told they had Angina or Coronary Artery Disease Percent of adults who have ever had a Stroke
Stroke
2007
2008
3.3%
3.9%
1.9%
2.0%
The 2003-2007 overall mortality rate for IHD in Cobb County is 86.2 per 100,000 population and below the Georgia rate at 117.6.
36
CHRONIC DISEASE In 2008, self-reported heart attack rates were higher in Cobb County compared to Georgia. However, Cobb County has lower rates than Georgia for mortality and hospitalizations due to ischemic heart disease (IHD) of which heart attack is a subset. Figure 5-3: Percent of Adults Ever Told They Had a Heart Attack Cobb County 2007-2008 7
6.3
6 5
4.3
4.1
3.9
4
Cobb
3
Georgia
2 1 0 2007
Table 5-2: Percent of Adult Residents who received Routine Medical Screenings, (Self-Reported) 2007 Percent of Adults who have never had a Blood Cholesterol Check Percent of Adults who have had a Blood Cholesterol Check and told it was High Percent of Adults with High Blood Pressure (District 3-1)
2008
2007 8.8% 3.4% 21.5%*
*Data is based on a compilation of years 2004-2007.
37
Cobb County Health Status Report, 2010
WHY IS CARDIOVASCULAR DISEASE IMPORTANT?
Cardiovascular (CVD) disease accounts for all diseases of the heart and blood vessels. CVD affects all geographic, gender and socio-economic groups. An estimated 80,000,000 American adults (one in three) have one or more types of cardiovascular disease (CVD). It is the leading cause of death in both men and women. The direct and indirect cost of cardiovascular diseases and stroke in the United States in 2009 is estimated to be $475.3 billion, according to the American Heart Association and the National Heart, Lung, and Blood Institute (NHLBI). The rise in CVDs reflects a significant change in diet, physical activity levels, and tobacco consumption worldwide. According to the World Health Organization, the most cost-effective methods of reducing risk among an entire population are population-wide interventions, combining effective policies and broad health promotion policies.
HOW DO WE COMPARE?
CVD is the leading cause of death in the U.S., Georgia and Cobb County.
It accounts for nearly 1/3 of all the deaths in Georgia.
Heart disease is the 2nd leading cause of premature deaths (<75 years) in Cobb County.
The age adjusted CVD mortality rate for Cobb County in 2007 was 209.3 deaths per 100,000 population, lower than that for Georgia (269.0) or for the United States (190.9).
38
WHY IS CARDIOVASCULAR DISEASE IMPORTANT?
WHAT YOU CAN DO ABOUT IT… RISK FACTORS What are the major risk factors you can modify, treat or control by changing your lifestyle or taking medicine? Tobacco Smoke High Blood Cholesterol High Blood Pressure Physical Inactivity Obesity and Overweight Diabetes Mellitus What other factors contribute to heart disease risk? Stress Alcohol Diet and Nutrition What are the major risk factors that can’t be changed? Increasing Age Male Sex (Gender) Heredity (Including Race)
PREVENTION
Don't smoke or use tobacco products.
Get active for 30 – 60 minutes per day.
Eat a heart-healthy diet by eating foods low in fat, cholesterol and salt. Ask your health provider about the DASH diet (dietary approaches to the prevention of hypertension.)
Maintain a healthy weight with a Body Mass Index (BMI) of <25.
Get regular health screenings for blood pressure, cholesterol, and diabetes
Sources: American Heart Association and The Mayo Clinic, 2010
TO LEARN MORE… Visit the following websites to learn more about cardiovascular disease.
39
Cobb County Health Status Report, 2010
CHRONIC DISEASE CANCER Cancer is a disease in which cells divide abnormally without control and can invade adjacent tissues. The cells can also metastasize and spread to other parts of the body through the blood and lymphatic system. Cancer is a leading cause of death in the U.S., Georgia and in Cobb County. Nearly 2/3rds of cancer deaths are associated with behavioral factors such as tobacco use, diet, obesity, and lack of physical activity. The mortality rate due to cancer increased in both Cobb County and Georgia from 2006 to 2007.
Age Adjusted Rate per 100,000 population
Figure 5-4: Mortality Rate due to Cancer, 2003-2007 Cobb
Georgia
250.0 196.1
196.1
156.4
166.3
186.6
200.0 150.0
154.3
100.0
178.3
179.4
140.5
149.9
50.0 0.0 2003
2004
2005
2006
2007
The occurrence of cancer can be greatly reduced by preventing or stopping tobacco use, improving diet, increasing physical activity and early detection examinations such as mammography, colorectal screening and Pap smears. There are vaccines available to prevent infections which can contribute to the development of certain types of cancer, such as Hepatitis B and HPV.
Table 5-3: Age Adjusted Mortality Rates* due to Leading Causes of Cancer by Gender, 2003-2007 Males Cobb Georgia Females Cobb Georgia Lung Cancer
53.7
80.6
Lung Cancer
32.5
39.8
Prostate Cancer
20.3
28.6
Breast Cancer
24.5
24.1
Colon Cancer
17.5
21.1
Colon Cancer
11.8
15.0
Pancreatic 11.4 Cancer
12.4
Pancreatic 8.1 Cancer
9.1
Leukemia
9.2
Ovarian Cancer
8.8
9.3
8.0
According to the American Cancer Society, cigarette smoking accounts for at least 30% of all cancer deaths, and is responsible for almost 9 out of 10 lung cancer deaths.
*Rate = number of deaths per 100,000 population.
40
CHRONIC DISEASE
Lung Cancer is the leading cause of cancer mortality for both men and women in both Cobb County and in Georgia. The 2nd leading cause of cancer mortality is prostate cancer for men and breast cancer for women. From 2003-2007, the age adjusted mortality rate due to breast cancer in Cobb County is slightly above the rate in Georgia (24.5 vs. 24.1 per 100,000 women). Both are above the 2003 -2007 mortality rate in the U.S. which was 24.0 per 100,000 women.
Table 5-4: Leading Causes of Cancer Incidence (New Cases) by Gender and Race Cobb County, 2003-2007 White Males Prostate Lung and Bronchus Colon and Rectum
Rate* 152.1 78.0 50.2
Black Males Prostate Colon and Rectum Lung and Bronchus
Rate* 246.8 58.6 57.1
White Females Breast Lung and Bronchus Colon and Rectum
Rate* 124.3 54.1 37.4
Black Females Breast Colon and Rectum Lung and Bronchus
Rate* 114.5 47.3 36.0
Melanoma
42.0
Leukemia
19.6
Melanoma
28.4
Pancreas
16.3
Bladder
41.1
NonHodgkin Lymphoma
19.1
Thyroid
19.1
Uterine Corpus
14.7
*Rate = new cases per 100,000 population.
In Cobb County from 2003-2007: The leading cause of new cancer cases in males was prostate cancer and in females was breast cancer. The incidence rate for lung and bronchus cancer in white males (78.0 per 100,000) is slightly higher than the US rate (73.6). The incidence rate of prostate cancer in black males (246.8 per 100,000) was much higher than the rate in white males (152.1). Both of these rates were higher than the incidence rates in the U.S. from 2003-2007: white males (150.4), black males (234.6). The incidence rate of breast cancer in white females (124.3 per 100,000) was higher than the rate in black females (114.5); however, the mortality rate due to breast cancer for black females (34.5 per 100,000) is higher than white females (23.7). The National Cancer Institute keeps a cancer registry of all diagnosed cancer cases in the U.S. called the Surveillance Epidemiology and End Results (SEER) registry. The stages of cancer in the registry are defined into the following summary stages which include: "In situ" or early cancer , "localized" cancer which has not yet begun to spread, "regional" cancer which has spread to local lymph nodes but not yet to distant organs, and "distant" cancer which has spread to distant organs.
41
Cobb County Health Status Report, 2010
CHRONIC DISEASE
Figure 5-5: Cancer Cases by Stage of Diagnosis Cobb County, 2003-2007 In Situ
Localized
Regional
The majority of cancer cases from 2003-2007 in Cobb County were detected in the localized state;
Distant
however, almost 20% of cancer cases were detected in the distant
18.6%
stage in which cancer has spread
11.9%
to distant organs.
19.1%
50.4%
BREAST CANCER Table 5-5: Percent of Adult Residents Reporting Routine Preventative Cancer Screenings, 2008
Cobb
Georgia
Percent of Females (40+) who have had a Mammogram within the past 2 years Percent of Females (50+) who have had a Mammogram within the past 2 years Percent of Females who have had a Pap Smear within the past 3 years Percent of Adults who have had a Blood Stool Test within the past 2 years Percent of Adults who have had a Sigmoidoscopy or Colonoscopy Percent of Males (40+) who have and a Prostate-Specific Antigen (PSA) Test in the last 2 years (District 3-1)
74.9%
78.9%
77.1%
83.4%
90.2%
87.6%
24.1%
24.4%
57.9%
62.2%
53.3*
57.2%**
*Data is based on a compilation of years 2004-2006
**2006 data
ď&#x201A;ˇ
In 2008, Cobb County had a smaller percent of residents reporting receiving routine cancer screenings including: mammography, fecal occult blood tests, sigmoidoscopy or colonoscopy and prostatespecific antigen tests.
ď&#x201A;ˇ
Cobb County residents are reporting less cancer screenings in 2008 than in 2006.
42
CHRONIC DISEASE Figure 5-6: Breast Cancer Cases by Stage of Diagnosis Cobb County, 2003-2007 In Situ
Localized
Regional
Distant
3.8% 24.5% 22.7%
48.9%
The majority of cancer cases from 2003-2007 in Cobb County were detected in the localized state; however, almost 20% of cancer cases were detected in the distant stage in which cancer has spread to distant organs.
Source: Georgia Comprehensive Cancer Registry
Cobb & Douglas Public Health employees and breast cancer survivors.
43
Cobb County Health Status Report, 2010
WHY IS BREAST CANCER IMPORTANT?
About 207,090 new cases of breast cancer will be diagnosed in women in the United States in 2010 (Komen.org). In Cobb County, breast cancer is the leading cause of new cancer in females (2003-2007), and the second leading cause of cancer mortality in women, after lung cancer. Education and training for women on self breast exams and appropriate screening continues to be critically important in achieving both early detection and treatment which lead to increased survival rates.
WHAT CAN YOU DO ABOUT IT?
Follow the recommended screening and early detection guidelines from the American Cancer Society Women age 40 and older should have an annual mammogram and an annual clinical breast exam. Women in their 20s and 30s should have a clinical breast exam performed by a health care professional every three years. Breast self-examination is an option for women starting in their 20s. Send a health-e-card to women you care about, reminding them that mammograms save lives. This electronic greeting card is available at www.cdc.gov/cancer/breast/. A cumulative total of one year or more of breastfeeding lowers breast cancer risk. Talk with your family physician about taking a Selective Estrogen Receptor Modulator (SERM) such as tamoxifen or raloxifene if you are at high risk for breast cancer; and about gene testing, and/or prophylactic mastectomy if you have a strong family history of breast cancer. Eat a low-fat diet, limit alcohol consumption, refrain from tobacco and exercise regularly.
44
WHY IS BREAST CANCER IMPORTANT?
HOW DO WE COMPARE? Breast cancer mortality rates (2003-2007) United States: 24.0 cases per 100,000 female population Georgia: 24.1 cases per 100,000 female population Cobb County: 24.5 cases per 100,000 female population
Did you know Cobb & Douglas Public Health offers a Breast Test screening program? Visit our website to learn more: www.cobbanddouglaspublichealth.org/ HealthAndWellness/WomensHealth/
Cobb County’s rate is slightly higher than Georgia and the US.
TO LEARN MORE…. The following two websites are recommended for more information: www.komenatlanta.org – Susan G. Komen Foundation; www.cancer.org - American Cancer Society
45
Cobb County Health Status Report, 2010
CHRONIC DISEASE ASTHMA Asthma is a chronic respiratory disease that affects the lungs. It causes recurring incidents of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Asthma can be controlled by medication and staying away from environmental triggers that can cause an attack. Common asthma triggers include tobacco smoke, dust mites, pollution, cockroaches, pets and mold. Asthma is most common in children but can affect all ages.
Source: Georgia Division of Public Health, OASIS
ď&#x201A;ˇ ď&#x201A;ˇ
From 2003-2007 in Cobb County, ages 1-12 were most affected by asthma symptoms that led to an emergency department visit at an overall rate of 1393.40 per 100,000 population. The 2003-2007 age-adjusted ED Rates in Cobb County due to asthma are much higher for blacks at 857.5 per 100,000 population compared to whites at 162.9. Figure 5-8: Percent of Adult Who Have Been Told They Currently Have Asthma 2002, 2006-2008
10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0
8.8
8.2 7.4
8.0
7.6
8.2
8.5 6.6 Cobb Georgia
2002
2006
2007
2008
46
WHY IS ASTHMA IMPORTANT?
Asthma is a chronic inflammatory disorder of the lungs and airways that causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. It is the most common chronic childhood disease and itâ&#x20AC;&#x2122;s prevalence among children has increased so much in the past 15 years that asthma is now considered to be a national epidemic. Challenging to diagnose and treat, asthma was the cause of more than 55,642 Emergency Department visits in 10,457 hospitalizations in 2007 in Georgia.
HOW DO WE COMPARE? 10%
of children in Georgia have asthma (2007)
8.8%
of adults in the US have asthma (2008)
8.5%
of adults in Georgia have asthma (2008)
6.6%
of adults in the Cobb County have asthma (2008)
399.9/100,000 76.9/100,000
rate of ED visits due to asthma in Cobb (2007) rate of hospitalizations for asthma in Cobb (2007)
48
WHY IS ASTHMA IMPORTANT?
WHAT YOU CAN DO ABOUT IT… Asthma cannot be cured, but it can be controlled. Proper diagnosis, severity and control assessments, and development of an appropriate plan of care can improve quality of life for people with asthma. Know the common triggers Take control of asthma Create an asthma management plan Exposure to the following enviAn asthma management • Reduce exposure to your ronmental irritants and allergens plan is a written guide set triggers. can cause an asthma attack. • Work with your doctor to create up by your doctor and you to help manage your an asthma management plan. • Tobacco smoke asthma, based on your indi• Monitor your breathing and • Dust mites airways with a peak flow meter, vidual needs. • Pets (animal dander) Your plan will tell you: as recommended by your • Cockroaches • What brings on your doctor. • Fungi and molds (indoor and asthma symptoms. • Treat symptoms early. outdoor) • How to avoid triggers and • Learn when to seek medical reduce exposure. help. • What medicines to take and when to take them. • When you should seek medical help.
TO LEARN MORE… Visit the website: http://www.health.state.ga.us/epi/cdiee/asthma.asp to learn more.
49
Cobb County Health Status Report, 2010
CHRONIC DISEASE DIABETES Diabetes mellitus is a disease characterized by high blood sugar levels. It is the result of the body's inability to produce and/or use insulin made by the pancreas. Diabetes is a leading cause of death in U.S., Georgia and in Cobb County. It can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Risk factors which contribute to the development of adult-onset diabetes (type 2) include older age, obesity, genetics, history of pregnancy-related diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. Minority populations including Hispanics, blacks, Asians and Pacific Islanders are at higher risk for developing the disease.
Age Adjusted Rate per 100,000 population
Figure 5-9: Mortality Rate due to Diabetes, 2003-2007 Cobb
Georgia
30.0 25.0
24.4
22.5
20.2
20.0
15.0
23.0
14.1
19.2
12.0
11.0
5.0 0.0 2004
In Cobb County, 2003-2007: ď&#x201A;ˇ The black mortality rate (22.5 per 100,000 population) is almost 2 times the white mortality rate (12.8)
15.6
15.5
10.0
2003
Diabetes Facts
2005
2006
ď&#x201A;ˇ
The age adjusted ED Visits rate was 121.6 per 100,000 o Black: 380.9 o Other: 107.9 (Asian, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, Multiracial)
2007
o
White: 79.7
Figure 5-10: Percent of Adults Ever Told They Are Diabetic, 2006-2008 12 10.1 10
9.9
9.1
8 6.3 6
6.3
5.2
Cobb Georgia
4 2
0 2006
2007
2008
50
CHRONIC DISEASE Figure 5-11: Percent of Adult Females Ever Told They Have Pregnancy Related Diabetes 2006-2008 3.5
3.1
3 2.5 2 1.5 0.9
1
1.1
Cobb
1.3 0.8
Georgia
0.3
0.5 0 2006
51
2007
2008
Cobb County Health Status Report, 2010
WHY IS DIABETES IMPORTANT? Diabetes is consistently in the top 10 leading causes of death in Georgia. In addition, for every death with diabetes as a primary cause, there are two other deaths in which diabetes is a contributing cause. It can lead to blindness, kidney failure, amputations, heart disease, stroke, hypertension, nerve damage, repeated infections, slow wound healing, sexual dysfunctions, skin disorders, periodontal disease, pregnancy complications, disability, and premature death. In Georgia...
DIABETES IS:
more common among black adults than among white adults 6 times more common among adults aged 65 years and older than among adults aged 18 to 34 years 3 times more common among adults whose annual household income was less than $15,000 than among adults in households that earned $75,000 or more a year significantly more common in adults with less than a high school education than among college graduates
WHAT YOU CAN DO ABOUT IT… Many complications of diabetes can be prevented with early detection, proper intervention, and comprehensive management. If you are diabetic, get checked…. √Blood sugar checked daily or as recommended
by your doctor
√Hemoglobin A1C checked at least twice a year
√Eyes dilated and checked at least once a year √Urine checked for the protein albumin as
needed √Feet checked daily and at all doctor visits
52
WHY IS DIABETES IMPORTANT?
Risk Factors for Developing Type 2 Diabetes Physical inactivity Unhealthy eating habits Advancing Age Pre-diabetes Past history of gestational Diabetes
Obesity Sedentary lifestyles Family history of diabetes Hispanic, Black, Asian, Pacific Islander Signs and Symptoms of Diabetes Frequent urination Extreme hunger Blurred vision Unexplained weight loss or gain infections Slow wound healing Tingling and numbness in hands or feet
Intense thirst Tiredness Irritability Repeated Dry, itchy skin
Know your ABCs and keep them at desirable levels as indicated below. A – Hemoglobin A1C
Less than 7%
B – Blood Pressure
Under 130/80
C – Cholesterol
Triglycerides: Below 150 mg/dL LDL (bad cholesterol): Below 100 mg/dL HDL (good cholesterol): Men – Over 40 mg/dL; Women – Over 50 mg/dL
A FEW MORE TIPS… Take medications as prescribed. Receive a flu shot every year and a pneumonia shot as needed. Maintain a healthy body weight. Control your blood pressure and cholesterol as required. Adopt healthy eating habit and follow an appropriate meal plan. Avoid risk behaviors such as smoking and excess drinking. Stay active. Walk, run, swim, dance, or get involved regularly in any kind of physical activity you enjoy.
53
TO LEARN MORE… http://www.health.state.ga.us/epi/cdiee/ diabetes.asp http://www2.niddk.nih.gov/ http://www.diabetesselfmanagement.com/ http://www.diabetes.org/
Cobb County Health Status Report, 2010
CHRONIC DISEASE CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that causes the air passages to narrow which then blocks airflow and makes it hard to breathe. Two main conditions of COPD are emphysema and chronic bronchitis. COPD causes a large percentage of morbidity and mortality in the U.S., Georgia and in Cobb County. Key risk factors for COPD include tobacco use, environmental factors (exposure to air pollutants such as dust and/or chemicals in the home and workplace) and heredity. Figure 5-12: Mortality Rate due to Chronic Obstructive Pulmonary Disease (COPD), 2003-2007
Age Adjusted Rate per 100,000 population
Cobb
The mortality rate due to COPD in Cobb County for 2003-2007 is higher for whites at 41.5 per 100,000 population compared to blacks at 16.9.
Georgia
60 50
48.5
46.8 37.1
40
46.3
44.3
43.2
42.3
38.6 35.6
33.6
30 20 10 0
2003
2004
2005
2006
2007
*Heavy drinkers defined as 3+ drinks/day for men and 2+ drinks/day for women
54
CHRONIC DISEASE ALCOHOL USE Excessive drinking both in the form of heavy drinking, or binge drinking is associated with numerous health problems, including: Cirrhosis (damage to liver cells) of the liver Pancreatitis (inflammation of the pancreas) Cancers, including liver, mouth, throat, larynx and esophagus High blood pressure Psychological disorders Unintentional injuries motor-vehicle crashes, falls, drowning, burns and firearm injuries Violence child maltreatment, homicide and suicide Poor birth outcomes fetal alcohol spectrum disorders; sudden infant death syndrome (SIDS) *Heavy drinkers defined as 3+ drinks/day for men and 2+ drinks/day for women
Figure 5-13: Percent of Adults Classified as Heavy Drinkers* 2002, 2006-2008 Cobb
Figure 5-14: Percent of Adults Who Have Had at Least One Alcoholic Drink within the Last Thirty Days 2002, 2006 - 2008
Georgia
Cobb
6.0 5.1
5.0 5.0 3.9
4.0
3.9
4.1
4.4
65.8
70.0 4.5
60.0 50.0
3.2
Georgia
56.6 49.3
60.1
58.2 45.5
48.4
46.8
40.0
3.0
30.0
2.0
20.0 1.0
10.0
0.0
0.0 2002
2006
2007
2008
2002
2006
2007
2008
*Heavy drinkers defined as 3+ drinks/day for men and 2+ drinks/day for women
55
Cobb County Health Status Report, 2010
CHRONIC DISEASE Figure 5-15: Percent of Adults who Binge Drink* 2006 - 2008 Cobb
Georgia
20.0
17.9
18.0
15.8
15.7
16.0
14.0
14.0
12.6
12.1
12.0 10.0 8.0 6.0 4.0
Cobb County has a higher percentage of adult binge drinkers than Georgia.
2.0 0.0 2006
2007
*Binge drinkers defined as 5+ drinks/day for men and 4+ drinks/day for women
2008
ALCOHOLIC LIVER DISEASE (CIRRHOSIS) Alcoholic liver disease is defined as damage to the liver and its function due to alcohol abuse. Alcoholic liver disease can start in the liver as inflammation (hepatitis) and progress to fatty liver and cirrhosis. Cirrhosis is scarring of the liver which effects liver functioning; it has multiple causes. Cirrhosis can cause health complications including bleeding disorders, as cites (fluid in the abdomen), portal hypertension, hepatic encephalopathy, kidney failure and liver cancer. Excessive alcohol use is a leading life-style related cause of death in the United States. Alcoholic liver disease usually occurs after years of extreme drinking. alcohol use Other factors that contribute to the development of alcoholic liver disease are genetics, personal susceptibility to alcohol-induced liver disease and toxicity of The mortality rate due to alcoholic liver disease remains low and has been sporadic from 2003-2007 in both Cobb County and in Georgia.
Age Adjusted Mortality Rate per 100,000 population
Figure 5-16: Mortality Rates due to Alcoholic Liver Disease 2003-2007 Cobb 3 2.5 2 1.5 1 0.5 0
Georgia
2.7
2.5
2.4 2.4 2.1
1.7
2.4 2.3
1.5 1.1
2003
2004
2005
2006
The rate in Cobb County during 2007 was slightly higher than in Georgia. This should be monitored based on the high self-reported rates of both binge drinking and heavy drinking Cobb County.
2007
56
CHRONIC DISEASE SMOKING Smoking harms nearly every organ of the body, causes many diseases, and reduces overall health. Smoking causes: Coronary artery disease
Reduced circulation (which increases the risk for peripheral vascular disease) Abdominal aortic aneurysm Lung Diseases including lung cancer, emphysema, bronchitis and chronic airway obstruction Cancers (acute myeloid leukemia, bladder, cervix, esophagus, kidney, larynx, lung, oral, pancreatic, pharynx, stomach and uterus)
Smoking has many adverse reproductive and early childhood effects including increased risk for infertility, preterm birth, stillbirth, low birth weight and Sudden Infant Death Syndrome (SIDS). The negative health outcomes from smoking attribute to an estimated 1 in 5 deaths each year or 443,000 deaths each year in the U.S.
Figure 5-17: Percent of Adult Population Who Are Current Smokers, 2002 , 20062008 Cobb 25.0
Figure 5-18: Smoking Status of Adults Cobb County, 2008
Georgia
23.2
20.0
17.4
18.8
19.9
19.4
18.4
Smoke Everyday
Smoke some days
Former smoker
Never Smoked
13.2%
19.5
5.2%
15.0 10.5
57.5%
10.0
24.1%
5.0 0.0 2002
57
2006
2007
2008
Cobb County Health Status Report, 2010
CHRONIC DISEASE Deaths from tobacco use surpass the total deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.
OVERWEIGHT/OBESITY Overweight and obesity are terms to describe weight that are above what is considered healthy. For adults, the terms are dependent on an individual’s body mass index. Overweight is defined as a BMI of 25 to 29.9. Obesity is defined as a BMI of 30 or higher.
CALCULATION OF BMI (SOURCE: CDC) BMI is calculated the same way for both adults and children. The calculation is based on the following formulas: Measurement Units Kilograms and meters (or centimeters)
Formula and Calculation Formula: weight (kg) / [height (m)]2 With the metric system, the formula for BMI is weight in kilograms divided by height in meters squared. Since height is commonly measured in centimeters, divide height in centimeters by 100 to obtain height in meters. Example: Weight = 68 kg, Height = 165 cm (1.65 m) Calculation: 68 ÷ (1.65)2 = 24.98
Pounds and inches
Formula: weight (lb) / [height (in)]2 x 703 Calculate BMI by dividing weight in pounds (lbs) by height in inches (in) squared and multiplying by a conversion factor of 703. Example: Weight = 150 lbs, Height = 5'5" (65") Calculation: [150 ÷ (65)2] x 703 = 24.96
58
CHRONIC DISEASE VISIT THIS WEBSITE FOR A BMI CALCULATOR FOR ADULTS: www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html
59
Cobb County Health Status Report, 2010
CHRONIC DISEASE Obesity and being overweight have been associated with increased risk of certain diseases and other health problems including: Coronary heart disease Type 2 diabetes Cancers (endometrial, breast, and colon) High Blood Pressure High total cholesterol or high levels of triglycerides
Stroke Liver and Gallbladder disease Sleep apnea and respiratory problems Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint) Gynecological problems (abnormal menses, infertility)
According to the CDC, in 2007-2008, the age-adjusted prevalence of obesity in the United States was 33.8% overall, 32.2% among men, and 35.5% among women. There are a variety of factors which contribute to being overweight or obese. These include caloric intake, environment, activity levels, genetics and medications. Figure 5-19: Percent of Adults who are Overweight by BMI, 2002, 2006 - 2008 Cobb
Georgia
Cobb
45.0 40.0
35.0 30.0
Figure 5-20: Percent of Adults who are Obese by BMI, 2002, 2006 - 2008 Georgia
35.0 35.4
36.3 34.6
36.3 33.4
38.336.9
29.9
30.0 25.0
25.0
20.0
20.0
15.0
15.0
27.1 23.5 20.3
28.7 23.2
18.6
27.8
21.0
10.0
10.0 5.0
5.0
0.0
0.0 2002
2006
2007
2008
A higher percent of residents reported being overweight in Cobb County compared to Georgia.
2002
2006
2007
2008
A lower percentage of residents reported being obese in Cobb County compared to Georgia.
EXERCISE Inactive children and adults are more likely to become obese, leading to increased health care costs and decreased quality of life. Regular physical activity improves your overall health and fitness, and reduces your risk for many chronic diseases.
60
CHRONIC DISEASE Figure 5-21: Percent of Adults Who Have Not Participated in Any Physical Activity During the Past Month 2002, 2006 - 2008 Cobb 30.0
25.7
25.0 20.0
17.8
24.7
Georgia 24.7
CDC Guidelines for Physical Activity
Children and adolescents (ages 6-17) should do 60 minutes (1 hour) or more of physical activity each day.
Adults should do 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking) every week and muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).
If you're 65 years of age or older, are generally fit, and have no limiting health conditions you can follow the guidelines for adults listed above.
23.1
17.0
15.9 13.2
15.0 10.0 5.0 0.0 2002
2006
2007
2008
NUTRITION The key to achieving and maintaining a healthy weight isn't about short-term dietary changes. It's about a lifestyle that includes healthy eating, regular physical activity, and balancing the number of calories you
61
Cobb County Health Status Report, 2010
INFECTIOUS DISEASES “Notifiable diseases” are specific infectious diseases that health providers and laboratories are required to report to their local or state health department. Cobb & Douglas Public Health (CDPH) monitors and investigates infectious diseases with the goal of preventing and controlling outbreaks in the community.
SEXUALLY TRANSMITTED DISEASES
Chlamydia Chlamydia, a common sexually transmitted disease (STD), is known as a "silent" disease because about ¾ of infected women and about ½ of infected men have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure. If untreated, chlamydia infections can progress to serious reproductive and other health problems with both short-term and long-term consequences.
64
INFECTIOUS DISEASES
Chlamydia Facts
According to 2008 data, Georgia
Chlamydia.
ranks 13th highest in the U.S. for rates of
Cobb ranked 3rd highest out of 159 counties for the number of th Chlamydia cases and 104 highest for the rate (cases per 100,000 population.) From 2003-2008,
In Cobb County, there is a much
larger percentage of females diagnosed with
Chlamydia than males (78.2% versus 22.8%).
However, the CDC estimates that the actual occurrence of chlamydia is similar among men and women.
highest rates of chlamydia cases in Cobb County and in Georgia occurred among persons 18-19 years of age.
The
In the U. S. (2008), the
In Cobb County (2003-2008), of the known cases where race was identified, the rate among the black population was 300.4 per 100,000 and 40.1 among whites.
In
Chlamydia rate among blacks was more than eight times higher than that of whites (1,519.3 vs. 173.6 cases per 100,000 population.)
65
64.7% of the cases reported in Cobb County for 2008, race is unknown.
Cobb County Health Status Report, 2010
INFECTIOUS DISEASES Gonorrhea Gonorrhea is a sexually transmitted disease that if left untreated can cause serious and permanent health problems in both men and women. In women, gonorrhea is a common cause of pelvic inflammatory disease. In men, gonorrhea can cause epididymtis, a painful condition of the ducts attached to the testicles that may lead to infertility if left untreated. Increases in drug resistant gonorrhea in 2007 led to changes in the national treatment guidelines.
Gonorrhea Facts
The south
has higher rates of gonorrhea than other US regions.
Georgia ranked 6th highest in the United States for its rate of gonorrhea (2008).
From 2003-2008, Cobb
County ranked 101st highest out of the 159 counties in Georgia for the rate of gonorrhea (cases per 100,000 population).
Gonorrhea rates for 20032008 were highest in
the 18-19 year old age group at a rate of 607 per 100,000 population for Cobb County and 1057 for Georgia.
In 2008, gonorrhea rates in the United States were highest
among girls 15 to 19 and women 20 to 24.
According to the Centers for Disease Control and Prevention, in 2008
blacks made up more than 70 % of gonorrhea cases but represent only 12 percent of the total U.S. population. The same pattern is consistent in Cobb County. 66
INFECTIOUS DISEASES Syphilis
Syphilis Facts
Syphilis is a sexually transmitted disease (STD) called “the great imitator” because so many of the signs and symptoms are similar to those of other diseases. It is initially characterized by the appearance of one or more sores called chancres. Without treatment, the infected person will continue to have syphilis even though signs or symptoms may not be present. In the late stages, the disease may damage internal organs and lead to death.
From 2003-2008, Georgia ranked 3rd highest in the United States for its rates of primary and secondary syphilis.
Cobb County ranked 7th highest out of Georgia’s 159 counties for the rate of syphilis (cases per 100,000).
According to CDC, the majority of reported syphilis cases in the U.S. are
among men who have sex with men (MSM).
In 2008, the gender of sex partners infected with syphilis showed that 63% of primary and secondary syphilis cases were among MSM, compared to only 4% of cases in 2000.
97% of syphilis cases in Cobb County (2003-2008) were in the male population.
The highest rates of syphilis cases in Cobb County occurred among persons 25-
29 years of age.
Within the U.S. in 2008, the
syphilis rate among blacks was about eight times than that of whites.
67
The syphilis rate by race in Cobb County (2003-2008) was 21.1 per 100,000 population for blacks, and 3.8 for whites.
Cobb County Health Status Report, 2010
INFECTIOUS DISEASES HUMAN IMMUNODEFICIENCY VIRUS (HIV) Human Immunodeficiency Virus (HIV) causes Acquired Immunodeficiency Syndrome (AIDS) and is transmitted by contact with infected body fluids: blood, semen, vaginal fluids and breast milk. The most common methods of transmission are sexual intercourse or sharing needles. Currently, there is no cure for HIV or AIDS.
68
INFECTIOUS DISEASES
In Cobb County (2008), the most
common method of transmission of HIV was male-to-male sexual contact (43.4%).
High risk heterosexual contact (12.6%) and injection drug use (7.5) were also methods of transmission.
Call Cobb & Douglas Public Health at 770-514-2464 to obtain HIV testing and counseling information.
69
Cobb County Health Status Report, 2010
WHY ARE INFECTIOUS DISEASES IMPORTANT?
Sexually transmitted diseases (also called sexually transmitted infections or STIs) are a major public health problem, affecting men and women of all backgrounds and economic levels. They are commonly transferred from one person to another through sexual contact and fall into two categories: bacterial or viral. Some of the most common STDs are Chlamydia, gonorrhea, syphilis and HIV. According to the CDC there are over 19 million new cases of STDs each year, almost half of them among young people ages 15-24. Those at increased risk are adolescents and young adults (15-24), persons who engage in unprotected sexual intercourse and injection drug users. Many STDs are easily treated with antibiotics; however, it is not uncommon for an STD to develop a resistance to some medications. Some STDs such as herpes, HIV, and genital warts are caused by viruses and
WHAT CAN YOU DO ABOUT IT? STDs are most commonly transmitted through sexual contact including anal, vaginal and oral sex, and/or needle sharing.
Abstinence is the only sure way to avoid STDs.
Reduce the number of your sex partners to minimize exposure.
Consistently use latex or polyurethane condoms during vaginal, anal and oral sex. Condoms are made for males and females.
STD screening part of your routine health care.
Make
Know the signs and symptoms of STDs and get checked
Consider vaccines that help protect you against certain STDs
by a health provider. Note: Signs and symptoms are not guaranteed; testing is the only way to know if you have an STD.
Hepatitis B virus (HBV), and Human Papillomavirus (HPV) infection
If you are treated for an STD,
take all the medication as prescribed and
abstain from sex until your health provider says it is safe.
Know your HIV status by getting tested
at your local health department or
by your healthcare provider.
If injecting drugs,
time.
do not share needles and use a clean needle each
70
WHY ARE INFECTIOUS DISEASES IMPORTANT? HOW DO WE COMPARE? The southern region of the U.S. has higher rates of primary and secondary syphilis and gonorrhea than other regions of the country. The South also has the greatest number of people estimated to be living with AIDS. Georgia – 2008 3rd highest state in primary and secondary Syphilis rates* at 9.6 compared to the U.S. rate of 4.5. th 6 highest state in Gonorrhea rates at 170.5 compared to the U.S. rate of 111.6. 14th highest state in Chlamydia rates at 446.6 compared to the U.S. rate of 401.3. 8th highest state in cumulative AIDS and HIV cases at 33,847 compared to 1,106,391 U.S. cases.
2003 – 2007 Cobb County ranking compared with the 159 counties in Georgia (higher ranking = higher rate)
7th for the rate of primary and secondary Syphilis cases 104th for the rate of Chlamydia cases 101st for the rate of Gonorrhea cases In 2008 District 3-1, Cobb & Douglas Counties, ranked 4th of the 19 Georgia health districts with 1,822 cumulative AIDS and HIV cases.
By state law, health providers, hospitals and laboratories must report cases of STDs to the state or local health department. For more information contact Cobb & Douglas Public Health. STD Surveillance Program 770-514-2452 STD Clinic appointment line 770-514-1504 CDS (HIV) Program 770- 514-2464
*Rates = number of cases per 100,000 population
TO LEARN MORE…. Visit the following websites to learn more. www.cobbanddouglaspublichealth.org
71
www.cdc.gov
Cobb County Health Status Report, 2010
INFECTIOUS DISEASES TUBERCULOSIS Tuberculosis (TB) is a bacterial disease caused by Mycobacterium tuberculosis. The most common site of disease is the lung, but other organs may be involved. TB disease in the lungs (or pulmonary TB) usually causes the following symptoms: coughing that lasts longer than 2 weeks, pain in the chest when breathing or coughing, and coughing up sputum or blood. A person can either have latent TB infection or active TB infection. Latent TB Infection (LTBI) is an infection with tubercle bacilli that are alive but inactive in the body. Persons with LTBI have no symptoms, do not feel sick, cannot spread TB to others; but, they may develop TB disease later in life if they do not receive treatment for LTBI.
Tuberculosis Facts
In 2009, Cobb County had a total of 18 active
cases of tuberculosis.
cases in Cobb County decreased by 30.8% from 2008 to The number of
2009. This decrease was also consistently seen throughout the state of Georgia.
From 2003-2009,
TB
occurred predominantly among men (63.2%) compared to women (36.8%).
highest number and proportion of TB cases by age group for both sexes occurred among persons 30 to 39, followed by the The
20 to 29 age group.
From 2003 to 2009, there were 25 cases of TB
in children (0-19 years) in Cobb County.
72
INFECTIOUS DISEASES
59% of TB cases in the U.S. occurred in foreign-born persons. Foreign-born persons have accounted for the majority of TB cases in the U.S. In 2008,
every year since 2001.
higher risk for TB are: Foreign born HIV infected Refugee or immigrant People living in close quarters (congregate setting)
Persons at
The most (2009) are:
frequent country of origin for foreign born TB cases in Cobb County
Mexico 21.1% India 10.5% Kenya 10.5% Brazil 10.5%
73
Cobb County Health Status Report, 2010
INFECTIOUS DISEASES HEPATITIS Hepatitis is a viral disease that causes inflammation of the liver. Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation. There are five different types of hepatitis: A, B, C, D and E viruses. In the state of Georgia, hepatitis A, B, and C are reportable and the most common type. Vaccination is available for hepatitis A and B but not for hepatitis C. Symptoms that are common to these three forms of acute hepatitis are nausea, vomiting, fatigue, jaundice (yellow eyes and skin), abdominal pain, clay-colored stools, joint pain and loss of appetite. Table 6-1: The ABCs of Hepatitis Hepatitis A Route or Transmission
Fecal Matter: Close contact or sexual contact with an infected person Ingestion of contaminated food or water
Potential for Chronic Infection
None
Vaccination
Yes 2 doses 6 months apart
Hepatitis B
Hepatitis C
Blood, semen, and other bodily fluids: Birth through an infected mother Sexual contact with an infected person Sharing needles or other drug equipment Needle stick or other sharp instrument injuries Among unimmunized persons: >90% of infants (less than 1 year) 25%-50% of children (1 to 5 years old) 6%-10% of older children and adults Yes
Primarily through blood: Sharing needles or other drug equipment Less commonly through: Sexual contact with an infected person Birth to an infected mother Needle stick or other sharp instrument injuries 75-85% of newly infected develop chronic infection
No vaccine available
Infants and children: 3 or 4 doses depending on vaccine type and schedule Adults: 3 doses over 6 month period
Hepatitis A has decreased 92.6% from 2003 (54 cases) to 2009(4 cases) in Cobb County.
There was an increase in Hepatitis A cases in 2007
due to multiple small
outbreaks that were within the same residence or family. Hepatitis B has decreased 74.5% from 2003 (34 cases) to 2009 (8 cases) in Cobb County.
74
INFECTIOUS DISEASES SEASONAL INFLUENZA Seasonal Influenza (flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and is a leading cause of hospitalization and death in Cobb County. Elderly individuals, young children, and people with certain health conditions are at high risk for serious complications. To protect yourself, it is important to get a flu vaccination every year because the viruses included in the vaccination change. The rate of hospitalizations due influenza (number of hospitalizations per 100,000 population), 2003-2007 4.4 Cobb County 10.8 Georgia Percent of adults 65+ who had a flu shot within the past year (2007) 82.3% Cobb County 67.7% Georgia Some healthcare providers in Cobb & Douglas Counties are a part of the CDCâ&#x20AC;&#x2122;s Influenza-Like-Illness (ILI) network providers. These providers report all cases of Influenza-Like-Illness (defined as fever and cough or other respiratory symptoms) which are seen in their facilities. They also randomly test for influenza and send samples to the state laboratory for surveillance purposes. This surveillance helps provide public health information on the influenza strains which are circulating in the community.
75
Cobb County Health Status Report, 2010
INFECTIOUS DISEASES H1N1 INFLUENZA In April 2009 a new and very different flu virus (called 2009 H1N1) spread worldwide causing the first flu pandemic in more than 40 years. The Centers for Disease Control and Prevention (CDC) expects the 2009 H1N1 virus to return in the 2010-2011 flu season along with other seasonal flu viruses. The 2010-2011 flu vaccine will protect against 2009 H1N1 and two other influenza viruses.
Unlike seasonal influenza, 2009 H1N1 primarily affected persons 49
and under.
PNEUMONIA Pneumonia is an infection of the lungs and can be caused by bacteria or viruses. Globally, pneumonia causes more deaths than any other infectious disease. The elderly (65 and older) and children younger than 5 years of age are at higher risk for pneumonia. There are vaccines available that prevent pneumonia.
76
INFECTIOUS DISEASES Percent of adults age 65+ who had a pneumonia vaccine (2007)
Cobb 79.7% Georgia 63.6% Did you know that influenza and pneumonia vaccines are available at Cobb & Douglas Public Health? Call 770-514-2417
VACCINE PREVENTABLE ILLNESS Prevention of disease is the foundation of public health. Vaccines help to prevent illnesses caused by either viruses or bacteria and can save lives. Vaccinepreventable diseases are costly to individuals and families, resulting in missed time from work, doctor's visits, hospitalizations, and possibly death. Vaccinations to prevent serious diseases are available at Cobb & Douglas Public Health (770-514-2417).
Table 6-2: Vaccine-Preventable Diseases (Cases) Cobb County 2003-2009 2003 2004 2005 2006
2007
2008
2009
Pertussis
1
6
7
4
3
3
17
Neisseria Meningitis
1
0
1
3
1
1
4
(Invasive) Haemophilus influenza*
1
5
5
5
5
9
17
12
15
29
22
25
15
23
Streptococcal pneumoniae*
77
Cobb County Health Status Report, 2010
INFECTIOUS DISEASES Pertussis
Cases in Cobb County increased from 3 to 17 from 2008 to 2009. During this time, Cobb County had an outbreak of pertussis in 4 local elementary schools. Many of the children were fully vaccinated. However, over time the vaccine’s effectiveness can decrease. Therefore a booster vaccination (TdaP) was licensed in 2005 for persons 10 to 64 years of age.
Pertussis is spread by direct contact with an infected individual through coughing and sneezing.
Prevention Strategies for Influenza, Pneumonia, Pertussis and Neisseria Meningitis
Haemophilus influenzae
Prior to the introduction of the Haemophilus influenza type b vaccination in 1985, this was the main cause of meningitis, bacteremia and pneumonia in infants and children.
Get vaccinated!
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
Streptococcus pneumoniae is a common cause of bacterial
Avoid touching your eyes, nose and mouth. Germs spread this way.
This bacterium is often found in the nose and throat without causing illness. However it is sometimes associated with mild illness, such as ear and sinus infections.
Try to avoid close contact with sick people.
If you are sick stay home for at least 24 hours after your fever is gone except to get medical care. Your fever should be gone without the use of a fever-reducing medicine.
While sick, limit contact with others.
Since this is a vaccine preventable diseases, we see very few cases every year in Cobb County.
This influenza is spread through direct contact with droplets from the nose or throat of an infected person or
Streptococcal pneumoniae meningitis, sepsis, and pneumonia.
As of 2008, there are two vaccines available The pneumococcal polysaccharide vaccine was introduced in 1983 and is recommended for all persons aged 65 years and older. The pneumococcal conjugate vaccine was introduced in 2001 and is recommended for all children beginning at age 2 months. This infection is spread person to person through droplets from the nose and throat.
78
INFECTIOUS DISEASES INVASIVE BACTERIAL DISEASES (NON-VACCINE PREVENTABLE) Invasive bacterial diseases can occur when a bacteria enters the body and causes an infection in a particular area. The following diseases (Table 6-3) can cause serious illness and possibly death. Table 6-3: Cases of Invasive Bacterial Diseases, 2003-2008 2003
2004
2005
2006
2007
2008
2009
Streptococcal Disease Group A
13
15
14
11
12
16
14
Streptococcal Disease Group B
24
35
41
34
37
46
49
Streptococcal Disease Group A
Group A Streptococcus (Streptococcus pyogenes) is a bacterium commonly carried in the throat and on the skin, often without symptoms. It usually causes mild illness such strep throat and impetigo. Occasionally life-threatening illness can occur, such as blood infections, toxic shock syndrome and necrotizing fasciitis. Antibiotics are commonly used to treat this infection. This infection is spread through contact with large respiratory droplets or direct contact with patients or carriers. It is rarely spread through contaminated objects.
Streptococcal Disease Group B
Group B Streptococcus (Streptococcus agalactiae) is a bacterium that colonizes in the colon and genital tract of women. It may cause infections in mothers and be passed to their infants at the time of delivery. It is the most common cause of sepsis and meningitis among newborns. It is common for an adult to carry this disease and have no symptoms. The mode of transmission in non-pregnant adults is unknown.
Methicillin-resistant Staphylococcus Aureus (MRSA)
Methicillin-Resistant Staphylococcus aureus (MRSA) has recently been recognized as a serious threat in the community. Initially, MRSA was a disease acquired only by patients who were hospitalized. However, now it can be acquired virtually anywhere. Athletes, children in childcare settings and congregate settings such as prisons and jails are at higher risk for MRSA. It is a resistant form of staph bacteria that is primarily spread through direct skin to skin contact. Data on community acquired infections is not currently available.
79
Cobb County Health Status Report, 2010
INFECTIOUS DISEASES GASTROINTESTINAL ILLNESS Intestinal diseases are infections that are commonly transmitted through consuming contaminated food, but can also be spread through contact with water, animals, and other environmental sources. In order for a person to be tested for an intestinal disease their doctor must collect a stool sample and send it to a laboratory for testing. Figure 6-14 below shows the most commonly reported gastrointestinal diseases in Cobb County. However, everyone doesnâ&#x20AC;&#x2122;t go to the doctor when they are ill and/ or do not have testing done, many cases of intestinal disease are not reported.
80
INFECTIOUS DISEASES
From 2005 to 2007 shigella cases increased attributed to the cyclical patter of shigella.
from 21 to 125. This is
Salmonella has consistently had the largest number of cases through 2003 to 2009.
Cobb County’s leading causes of gastrointestinal illness mirrors the national leading causes.
FOODBORNE OUTBREAKS The CDC considers a foodborne disease outbreak a cluster of two or more infections caused by the same agent (pathogen or toxin) linked to the same food. CDPH Environmental Health staff regularly inspect restaurants and investigate potential outbreaks. Between 2005-2009 there were 7 confirmed foodborne outbreaks in District 3-1 (Cobb & Douglas Counties). However some outbreaks go unreported.
81
Cobb County Health Status Report, 2010
WHY IS FOODBORNE ILLNESS IMPORTANT?
While the food supply in the United States is one of the safest in the world, each year about 76 million illnesses occur, more than 300,000 persons are hospitalized, and 5,000 die from foodborne illness. Tracking single cases of foodborne illness and investigating outbreaks are critical public health functions in which the CDC and state and local health departments are involved.
WHAT YOU CAN DO ABOUT IT… You can help prevent food poisoning from bacteria and viruses by following four simple steps when you prepare food.
The Basics: Clean, Separate, Cook and Chill
CLEAN
Wash hands and surfaces often
SEPARATE
Don't cross-contaminate!
COOK
Cook to proper temperature
CHILL
Refrigerate promptly
HOW DO WE COMPARE? According to the CDC, the number of outbreaks reported in 2009 by states ranged from 0 to almost 200. These numbers probably reflect the varying capacity in local health departments to detect outbreaks rather than an actual difference in the number of outbreaks per state. From 2005-2009 District 3-1 (Cobb and Douglas counties) had a total of 7 confirmed foodborne illness outbreaks. In Cobb County the top three foodborne illnesses are campylobacter, salmonella and shigella, which is consistent with the top three foodborne illnesses in Georgia and nationally. The CDPH Epidemiology and Environmental Health Programs investigate foodborne illness complaints and outbreaks. Call the Environmental Health Program at 770-435-7815 to report a foodborne illness after eating at a restaurant. For more information on foodborne illnesses please call the CDPH Epidemiology Office at 770-514-2432.
82
WHY IS FOODBORNE ILLNESS IMPORTANT?
TO LEARN MOREâ&#x20AC;Ś The following websites provide food safety tips and health information on foodborne illnesses: www.FoodSafety.gov
www.cdc.gov/footnet
www.fsis.usda.gov
For Cobb County restaurant inspection scores, visit the website: http://www.cobbanddouglaspublichealth.org/Programs/EnvHealth/Restaurants/cobbscores Source: www.cdc.gov/foodnet
83
Cobb County Health Status Report, 2010
MATERNAL & CHILD HEALTH At the beginning of the 20th century, for every 1000 live births, six to nine women in the United States died of pregnancy-related complications. In 1900 in some U.S. cities, up to 30% of infants died before reaching their first birthday. From 1915 through 1997, the infant mortality rate declined greater than 90%. This remarkable decline is a result of: environmental interventions, improvements in nutrition, advances in clinical medicine and access to health care, improvements in surveillance and monitoring of disease, increases in education levels, and improvements in standards of living. Despite this dramatic decline however, challenges remain. Perhaps the greatest is the persistent difference in maternal and infant health among various racial/ethnic groups, particularly between black and white women and infants. (CDC) This chapter presents data on maternal and child health issues in Cobb County.
PREGNANCY Pregnancy rates in the U.S. rose steadily from 1970 until reaching a peak in 1990. From 1990-2004, pregnancy rates were on the decline. In the young teens (15-19 years old) population, pregnancy rates declined 48% and older teens (18-19 years old) fell by 30%. From 2005-2006, slight increases in teen pregnancy, births and abortions were seen across the U.S. Additionally, preliminary 2007 data suggests an increase in birth rate in both the teen and young adult populations. This data will be monitored to determine if the increases will continue. It is thought that increases in pregnancy rate are affected by changes in the minority populations, increases in poverty, abstinence-only sex education programs, and changes in attitude toward teenage and unintended pregnancy.
Rate per 1,000 female population
Figure 7-1: Pregnancy Rates by Age Group Cobb County, 2003-2007 15-19 200.0
20-29
Pregnancy Facts
30-44
155.2
152.9
156.1
163.0
166.0
71.4
72.7
72.2
73.9
75.4
50.7
54.8
48.8
51.5
53.1
2003
2004
2005
2006
2007
ď&#x201A;ˇ
The overall pregnancy rate for Cobb County from 2003-2007 was 61.4 per 1,000 female population, which was greater than the pregnancy rate in Georgia of 58.8.
ď&#x201A;ˇ
Cobb County ranked 23rd lowest out of 144 Georgia counties for the teen (15-17 year old) pregnancy rate in 2007.
150.0
100.0 50.0 0.0
85
MATERNAL & CHILD HEALTH Figure 7-2: Pregnancy Rate by Race/Ethnicity Cobb County, 2003-2007
Rate per 1,000 female population
White
Black
Hispanic
200.0 134.9
150.0
144.0
139.2
130.7
139.3
100.0 77.3
50.0
56.3
68.8 59.2
67.2 58.3
66.7 59.0
69.9 57.0
In 2003-2007, Hispanic women in Cobb County have consistently had the highest rates of pregnancy.
0.0 2003
2004
2005
2006
2007
TEEN PREGNANCY Teen (15-19 years old) pregnancy reached an all time low in the United States in 2005; however in 2006, a 3% increase marked the 1st increase in teen pregnancies in over a decade. Teen mothers have higher rates of preterm babies, low birth weight babies, and infant mortality. They are also more likely to drop out of school and remain single compared to those who delay pregnancy. Children of teenage mothers are more likely to have developmental delays, and poor physical and mental health. ď&#x201A;ˇ Teen (15-19 years old) pregnancy rates increased in both Cobb County and Georgia in 2006 and 2007 which follows the national trend. Cobb County went from a teen pregnancy rate of 50.7 per 1,000 female population in 2003 to 53.1 in 2007. ď&#x201A;ˇ Cobb County remains under the Georgia rate for teen pregnancy. From 2003-2007, the rate for teen pregnancy was 51.8 per 1,000 female population for Cobb and 68.8 for Georgia. Sources: Georgia Division of Public Health, OASIS; Guttmacher Institute. U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity; CDC. Preventing Teen Preg-
nancy: An Update in 2009.
86
Cobb County Health Status Report, 2010
MATERNAL & CHILD HEALTH Figure 7-3: Teen (15-19 years old) Pregnancy Rate by Race\Ethnicity Cobb County, 2003-2007 White
Black
Rate per 1,000 female population
201.5
200.0
162.5
160.1
170.3
159.2
150.0 75.2
59.0
69.2
74.1
69.1
50.0 44.4
51.6
From 2003-2007, Hispanic teens (15-19 years old) had the highest pregnancy rate.
ď&#x201A;ˇ
Increases in the Cobb County teen pregnancy rate were seen in all races in 2006 but only in blacks and Hispanics in 2007; the white teen pregnancy rate decreased in 2007.
Hispanic
250.0
100.0
ď&#x201A;ˇ
42.3
46.0
45.1
0.0 2003
2004
2005
2006
2007
In Cobb County (2008), repeat teen births occurred most often in the 18-19 year old age group.
Table 7-1: Repeat Teen Births Cobb County, 2008 Age of Mother 10 to 14 15 to 17 18 to 19
Number of Births 0 32 125
PRENATAL CARE Women who see a health care provider regularly during pregnancy have healthier babies, are less likely to deliver prematurely, and are less likely to have other serious problems related to pregnancy. The Kotelchuck index, also called the Adequacy of Prenatal Care Utilization (APNCU) Index, uses two elements obtained from birth certificate data: a) when prenatal care was initiated and, b) the number of prenatal visits from when prenatal care began until delivery. The final Kotelchuck index measure combines these two dimensions into a single summary score.
87
MATERNAL & CHILD HEALTH Figure 7-4: Percent of Births with Inadquate* Prenatal Care Cobb County, 2002-2006 White 35 14.4
Percent of Births
30
15.8
Black
Between 20032007, Hispanic women had the highest number of births with an inadequate kotelchuck index, followed by blacks and then whites.
Hispanic
15.6
14.5 13.2
25 20 15
9.0
7.9
8.8
7.4
7.4
5.7
6.1
6.5
6.2
6.8
2002
2003
2004
2005
2006
10 5 0
*Based on the Kotelchuck index. Inadequate prenatal care is defined by a score of 79% or less on the Kotelchuck Index.
ABORTIONS The CDC began collecting abortion data in 1969 to document the number and characteristics of women who obtain a legal abortion. A legal abortion is defined as a procedure performed by a licensed clinician to induce the termination of a pregnancy.
Rate per 1,000 female population (15-44 years)
Figure 7-5: Induced Terminations, 1998-2007 40 35 30 25 20 15 10 5 0
Cobb Georgia White
Black
Hispanic
Cobb
12.1
33.6
16.8
Georgia
9.3
25.7
14.1
88
ď&#x201A;ˇ
The number of abortions reported in Cobb County from 1998-2007 was 26,532 and the rate was 17.8 per 1,000 female population.
ď&#x201A;ˇ
Cobb County ranked 4th highest out of 157 counties in Georgia (2 counties did not have data) for the rate of induced terminations from 1998-2007.
Cobb County Health Status Report, 2010
MATERNAL & CHILD HEALTH INFANT MORTALITY The infant mortality rate is the number of deaths among infants less than one year of age per 1,000 live births. Infant mortality is often used as an overall indicator of health in an area. It can reflect the health of the mother, the quality and access to care, socio-economic conditions and public health practices. The most common causes of infant mortality in Georgia include prematurity, birth defects and sudden infant death syndrome (SIDS). Risk factors which contribute to infant mortality and low birth weight (<2500 grams) babies include pregnancy in adolescents, births with multiples, poor maternal health and nutrition, inadequate or late prenatal care, infections, drug use, alcohol and tobacco use, closely spaced pregnancies, poor prenatal care and positioning of sleeping babies. Figure 7-6: Infant Mortality, 2003-2007 Rate per 1,000 live births
9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0
Cobb County ranked 10th lowest out of the 50 more populated counties in Georgia for infant mortality in 2007. 2003
2004
2005
2006
2007
Cobb
4.8
6.0
5.3
8.0
6.1
Georgia
8.5
8.5
8.0
8.1
7.9
Figure 7-7: Infant Mortality by Race/Ethnicity Cobb County, 2003-2007 White
18
Black
15.4
16
Rate Per 1,000 Live Births
Hispanic
14
12.4
11.6
12
10.1
10 8 6 4
6.8 4.6 3.3
5.7 3.9
3.3
3.6
5.6 4.1
3.1
2.2
2 0 2003
2004
2005
2006
2007
Infant mortality rates have been consistently higher in the black population from 2003 through 2007 in Cobb County. This may be attributed to a higher percentage of low birth weight babies in the black population.
89
MATERNAL & CHILD HEALTH Table 7-2: Top Causes of Infant Deaths Cobb County, 1998-2007 Cause of Death
Number of Deaths
Birth Defects
144
Prematurity
115
SIDS
60
Major Cardiovascular Diseases
34
Birth Related Infections
24
Total
666
LOW BIRTH WEIGHT BIRTHS Babies born weighing less than 5 pounds, 8 ounces (2,500 grams) are considered low birth weight. Low birth weight babies are at increased risk for serious health problems, lasting disabilities, and even death. ď&#x201A;ˇ In Cobb County, from 2003-2007, 8.1% of births were babies with low birth weights, compared to 9.4% for Georgia. ď&#x201A;ˇ In 2007, Cobb County ranked 48th lowest out of 156 counties in Georgia for percent babies with a low birth weight.
Figure 7-8: Percent of Low Birth Weight Babies by Race/Ethnicity Cobb County, 2003-2007 White 14
11.5
12
Black
Hispanic
12.8
12.7
13.2
6.9
6.7
11.0
10 7.0
8
6.2
6.1
5.6
5.8
6.2
6.0
5.6
2003
2004
2005
2006
2007
6 4
Black females continue to give birth to low birth weight babies at a higher percentage than whites and Hispanics.
2
0
Source: Online Analytical Statistical Information System (OASIS).
90
Cobb County Health Status Report, 2010
WHY IS PRENATAL CARE AND LOW BIRTH WEIGHT IMPORTANT? Mothers who do not receive prenatal care are 3 times more likely to have low birth weight (less 5 ½ lbs) babies and increase the risk for a poor maternal/infant medical outcomes. Teenage mothers, women carrying multiples, and African American women are at higher risk for delivering low birth weight babies.
Early and continued prenatal care can reduce or prevent medical risks for a mom and her baby.
Early prenatal care can detect and treat existing medical conditions and reduce medical complications for a mom and her baby.
Early lab testing can lead to early detection and treatment which can prevent and reduce medical complications.
WHAT YOU CAN DO ABOUT IT…… If you are pregnant Start prenatal care early (by six weeks gestation) and continue throughout the pregnancy. Don’t use drugs, alcohol and tobacco products during the pregnancy. Eat 5-10 fruits and vegetables every day. Take prenatal vitamins and iron as prescribed. Gain an appropriate amount of weight during pregnancy. Become educated about pregnancy. Obtain a vaccination against the seasonal flu virus. Seek genetic counseling if maternal age is over age 35 yrs. or if there is a family history of genetic abnormalities.
Brush your teeth regularly and see a dentist during pregnancy.
Uninsured or low income pregnant women can go to Cobb & Douglas Public Health for Pregnancy Medicaid, prenatal assessment and access to local medical providers, as well as WIC and nutrition classes. Call 770-514-2300.
91
WHY IS PRENATAL CARE AND LOW BIRTH WEIGHT IMPORTANT? HOW DO WE COMPARE?
952 (8.4%) of infants were born with low birth weights (less than 2500 grams) compared to Georgia at 9.5%. (2007)
1,231 (10.9%) of infants were born premature (before 37 weeks gestation) compared to the Georgia at 14.1%. (2007)
352 (3.8%) of women had less than 5 prenatal care visits compared to Georgia at 6.0% (2007)
298 (2.8%) women had late or no prenatal care compared to Georgia at 4.1%. (2006)
TO LEARN MORE… The following websites provide additional information. 1. 2. 3. 4.
http://www.cdc.gov http://www.whattoexpect.com/what-to-expect/landing-page.aspx http://www.marchofdimes.com/georgia/ http://www.pregnancy.com/
92
Cobb County Health Status Report, 2010
MATERNAL & CHILD HEALTH BREASTFEEDING BREASTFEEDING FACTS
From 2004-2006, Georgia consistently fell below the Healthy People 2010 goal of the percentage of mothers that breastfeed their infants. In 2006, the highest percentage of mothers who breastfeed their infants were Hispanics at 78.3% followed by whites at 75.1% and blacks at 58.2%.
The Pregnancy Risk Assessment Monitoring System (PRAMS), reports that from 2004-2006, 69.1% of mothers who delivered a live birth in Georgia breastfed their baby (for any length of time). The Healthy People 2010 goal is to increase the percentage of mothers who ever breastfeed their babies to 75%.
Figure 7-9: Percent of Mothers who Reported Ever Breastfeeding their Infant in Georgia, 2004-2006 100 80
70.4
67.0
69.9
2004
2005
2006
60 40 20
0
CHILDHOOD MORBIDITY (INJURY AND ILLNESS) Injury is the leading cause of Emergency Department visits in children 1-19 years of age in Cobb County. (2003-2009) Table 7-3: Leading Causes of Emergency Department (ED) Visits in Children 1-19 Years of Age in Cobb County, 2003-2007 Major Disease Category Number of ED ED Visit Rate per Visits 100,000 population 73,667 8149.4 All External Causes 21,537 2382.5 Falls 6,614 731.7 Motor Vehicle Accidents 49,092 5430.8 All Respiratory Diseases 8,045 890.0 Asthma 5,196 574.8 Pneumonia 16,813 1859.9 Infectious and Parasitic Diseases 15,090 1669.3 Digestive System Diseases 7,860 869.5 Reproductive and Urinary System Diseases
93
MATERNAL & CHILD HEALTH CHILDHOOD IMMUNIZATION Vaccines are responsible for the control of many infectious diseases that were once common in this country, including polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, and Haemophilus influenzae type b (Hib). These diseases may lead to serious illness and death. It is important that vaccination levels remain high to prevent outbreaks. The results of the 2008 Georgia Immunization Study indicate District 3-1 (Cobb and Douglas Counties) immunization coverage estimate for the 4:3:1:3:3:1* vaccination series is 76.0%. This rate is lower than the statewide immunization rate of 77.8%. *The 4:3:1:3:3:1 vaccine series includes: four diphtheria, tetanus and pertussis (DTP/DTaP); three polio (OPV/IPV); one measles, mumps, rubella (MMR); three Haemophilus influenzae type b (Hib), three hepatitis B (HepB), and one varicella.
Table 7-4: Percent of Children Receiving Immunizations On Schedule by Study Year District 3-1, 2004-2008 2004 2005 2006 2007 4 DTP/DTaP 78.8 79.0 75.2 83.6 3 OPV/IPV 83.5 86.2 83.5 90.7 1 MMR 86.3 82.1 87.2 88.5 3 Hib 82.1 84.1 86.2 86.7 3 HepB 83.0 83.6 86.7 90.7 1 Varicella 83.5 82.6 84.9 86.7
2008 86.0 93.9 91.1 86.0 91.6 89.9
YOUTH RISK BEHAVIORS Health risk behaviors are often established during childhood and adolescence and can extend into adulthood. Therefore, encouraging the adoption of healthy behaviors during childhood is easier and more effective than trying to change unhealthy behaviors during adulthood. According to the CDC Youth Risk Behavior Survey, far too many youth nationally and in Cobb County are still engaging in risky behaviors that have a negative impact on their health such as tobacco and alcohol use.
94
Cobb County Health Status Report, 2010
MATERNAL & CHILD HEALTH YOUTH OBESITY Obesity in children and adolescents continues to be a major public health concern in the U.S. Obesity in children is based on the 2000 CDC Growth Charts. These growth charts reflect age, sex and body mass index (BMI). BMI for children is calculated in the same manner as for adults (weight/(height)2) but obesity in children is defined differently. Children are considered obese if they are ≥ 95th percentile (based on CDC Growth Charts) for BMI. Visit the following website for a BMI Calculator for children and
Children who are obese may experience immediate health issues. Obesity can lead to high blood pressure, cholesterol, type 2 diabetes, asthma, and sleep apnea. Children also may also face emotional issues due to their weight. In 2009, 12.4% of Georgia youth were estimated to be obese compared to the U.S. rate at 12.0%. Black youth had the highest percentage of obesity at 13.2%, compared to whites at 12.5% and Hispanics at 11.0%. Georgia had significantly higher rates than the U.S. on a number of risk factors related to being overweight and obesity. Of High School Student in Georgia in 2009: 82.9% reported eating fruits and vegetables less than five times per week compared to 77.7% in the U.S. 56.4% reported not attending physical education classes in an average week (when in school) compared to 43.6% in the U.S. 39.2% reported watching television for 3 or more hours per day compared to 32.8% in the U.S.
95
WHY IS CHILDHOOD OBESITY IMPORTANT?
Obesity is a serious health concern for children and adolescents. Results from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) indicate that an estimated 17% of children and adolescents ages 2-19 are obese. In Georgia, approximately 15% of children in the WIC (Women, Infants & Children) program, 24% of third graders, 15% of middle school students and 14% of high school students are obese. (2009 Georgia Data Summary: Obesity in Children and Youth) Obese children and adolescents are at risk for health problems during their youth and as adults. They are more likely to have risk factors associated with cardiovascular disease such as high blood pressure, high cholesterol, and Type 2 diabetes. They are also prone to become inactive and obese as adults, leading to increased health care costs and decreased quality of life.
In Georgiaâ&#x20AC;Ś 55% 44% 52% 22%
middle school students that met requirements for physical activity high school students that met requirements for physical activity 5th and 7th grade students who did not pass a cardiovascular health assessment 5th and 7th grade students who did not meet standards of muscular strength and flexibility
39% 34% 66% 54% 19% 22%
middle school students who attend daily physical education classes high school students who attend daily physical education classes middle schools that offer intramural activities to students high schools that offer intramural activities to students middle school students who live one mile or less from school and walk to school high school students who live one mile or less from school and walk to school
44% 43% 19%
middle school students who watch TV for 3 or more hours on a school day high school students who watch TV for 3 or more hours on a school day high school students who consume 5 or more servings of fruits and vegetables daily
The percent of high school students and adults who consume the minimum recommended servings of fruits and vegetables are consistently low across all sex, race, ethnic, and age groups 12% 10%
middle schools that have a policy to offer fruits and vegetables in school settings high schools that have a policy to offer fruits and vegetables in school settings
Less nutritious snack foods and beverages are readily available in many middle school (39%-63%) and high school (75%-89%) vending machines.
Recommended physical activity in Georgia
Policies and environments in schools and communities influence physical activity behaviors Poor diet and physical inactivity are reasons for the rise in childhood obesity
School policies and environments influence healthy eating behaviors
Source: Georgia Division of Public Health, 2009 Georgia Data Summary: Obesity in Children and Youth, Physical Activity in Youth, Healthy Eating
97
WHY IS CHILDHOOD OBESITY IMPORTANT?
WHAT YOU CAN DO ABOUT IT… At Home
In Schools
Reduce screen time. (television, video games, computers)
Build physical activity into regular routines
In the Community
Adopt policies, environmental features, and provide programs supporting healthy diets and regular physical activity Ensure school breakfast and lunch programs meet nutrition standards Provide food options that are low in fat, calories, and added sugars Provide all children, from Pre-K through grade 12, with quality daily physical education
TO LEARN MORE… Please visit these websites to learn more.
Create safe and supportive environments for healthy eating and physical activity Promote healthier food choices including at least 5 servings of fruits and vegetables a day Encourage the food industry to provide reasonable portion sizes for food and beverages Encourage food outlets to increase the availability of low-calorie, nutritious food items Create opportunities for physical activity in communities
http://health.state.ga.us/epi/cdiee/obesity.asp http://www.cdc.gov/obesity/resources.html http://www.nhlbi.nih.gov/health/dci/Diseases/obe/ obe_whatare.html http://www.mypyramid.gov/
98
Cobb County Health Status Report, 2010
MATERNAL & CHILD HEALTH ALCOHOL USE Across the U.S, it is illegal for youth under the age of 21 to purchase alcohol. Underage drinking (defined as having a drink in the past 30 days) in U.S. high school students decreased from 50% in 1999 to 42% in 2009. In 2009, 24% of students reported binge drinking (5 or more drinks within a couple of hours on one day) in the U.S. Cobb County data is not fully comparable to the U.S. due to the inclusion of middle school students in the county data. Figure 7-10: Percent of Students who Reported Alcohol Use in the Past 30 days by School Year 2008-09 through 2009-10 18.0 16.0
16.4
15.7
15.4
14.4
14.0
14.0 12.0
10.5
10.0
Cobb County
8.0
Marietta City
6.0
Georgia
4.0 2.0 0.0 2008-09
In school years 2008-09 and 2009-10, Cobb County had a higher percentage of students reporting alcohol use compared to the state of Georgia.
2009-10
*The Georgia Student Health Survey Report data from grades 6, 8, 10 and 12. Marietta City School data in 2007-08 does not include 6th grade.
According to the Georgia Student Health Survey, the average age of onset use of alcohol in Marietta City Schools is 12.4 for males and 12.6 for females.
Table: 7-5 Average Age of Onset Use of Alcohol School Year 2009-10 School Males Females System Cobb County 13.0 13.2 Marietta City 12.4 12.6 Georgia 12.7 13.1 Source: Georgia Department of Education, Georgia Student Health Survey
99
MATERNAL & CHILD HEALTH BINGE DRINKING On the Georgia Student Health Survey, binge drinking was defined as having 5 or more drinks during one sitting in the past 30 days.
Figure 7-11: Percent of Students who Reported Binge Drinking in the Past 30 days by School Year 2007-08 through 2009-10 10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0
9.5 8.3
8.8
8.4
8.4 5.2 Cobb County Marietta City
2008-09
2009-10
Cobb County
9.5
8.4
Marietta City
8.3
5.2
Georgia
8.8
8.4
Georgia
*The Georgia Student Health Survey Report data from grades 6, 8, 10 and 12. Marietta City School data in 2007-08 does not include 6th grade.
YOUTH SMOKING The Campaign for Tobacco Free Kids, estimates that 90% of all tobacco use starts during adolescence. Two-thirds will become addicted by the age of 20. National rates of youth smoking have remained stable over the past few years and it is estimated that 20% of high school students in the U.S. are smokers. Over the past few years, the reported rate of smokeless tobacco (chewing tobacco) use has increased. In 2009, 8.9% of high school students reported using smokeless tobacco within the past month; rates were higher among males.
In 2009-10, 8.4% of the Cobb County students surveyed reported binge drinking within the past 30 days.
Some risk factors associated with youth tobacco use include low socioeconomic status, tobacco use by family and friends, lack of skills to resist tobacco use, lack of parental support or involvement, ease of access to tobacco products, low levels of educational achievement, low self esteem and aggressive behavior (e.g., fighting, carrying weapons). Smoking can cause bad breath, coughing, increased heartbeat and blood pressure, respiratory problems, reduced immune function, increased illness, tooth decay, gum disease, and pre-cancerous gene mutations. Smoking during youth is also associated with an increased likelihood of high risk sexual behavior and using illegal drugs and alcohol.
100
Cobb County Health Status Report, 2010
MATERNAL & CHILD HEALTH Figure 7-12: Percent of Students Who Reported Yes to Tobacco Use Within the Past 30 Days, 2008-2009 Marietta City Schools 25.0 20.0 15.0 10.0 5.0 0.0
Cobb County Schools
Georgia
6th
8th
10th
12th
Marietta City Schools
0.4
7.0
7.9
9.6
Cobb County Schools
0.9
3.0
10.9
15.6
Georgia
2.4
8.0
15.4
21.2
Grade
SMOKELESS TOBACCO Figure 7-13: Percent of Students who Report Using Chewing Tobacco in the Past 30 Days School Year 2007-08 through 2009-10 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0
4.2
4.1
2.7 2.3
2.3
Cobb County 1.7
Marietta City Georgia
2008-09
2009-10
*The Georgia Student Health Survey Report data from grades 6, 8, 10 and 12. Marietta City School data in 2007-08 does not include 6th grade.
101
BEHAVIORAL HEALTH “Behavioral health” refers to how a person’s mental well-being affects his or her actions and ability to function. Major areas within behavioral health are mental disorders and addictive diseases. “Behavioral healthcare” refers to a continuum of services for individuals at risk of or suffering from mental, addictive or other behavioral health disorders. Currently, there is no methodology in place to capture data that would provide an overall picture of the status of behavioral health in Cobb County. For purposes of this report, available national data are applied to county population estimates to show prevalence estimates of certain disorders among adults. Additionally, service data from the Cobb Community Services Board (CSB) are included to give further insight into behavioral health in the county. The Cobb CSB is the public provider of behavioral healthcare services in the county. Figure 8-1 shows the types of services provided by the agency. The Cobb CSB is not the sole provider of behavioral health services in the county. Many individuals receive these services from private providers, including personal physicians.
103
Cobb County Health Status Report, 2010
BEHAVIORAL HEALTH MENTAL DISORDERS Mental disorders are common in the U.S., and can begin at any age without respect to gender or sex. While there is no specific identifiable cause of mental disorders, they are thought to be caused by a variety of biochemical, genetic, and environmental risk factors. Many people suffer from more than one mental disorder at any given time. In the U.S., mental disorders are diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
According to the National Institute of Mental Health:
26.2% of the U.S. population ages 18 and older,
or about one in four adults, suffer from a diagnosable mental disorder in a given year. This translates to an estimated 57.7 million persons in the U.S.
1 in 17 Americans over age 18 suffers from a serious mental illness.
Mental Disorders in Cobb County
(Estimates based on US Census Bureau’s 2009 population estimates and NIMH prevalence data translated to Cobb County)
138, 377 (26.3%) persons age 18 and older suffer from a mental disorder in a given year. 31,068 (5.9%) persons ages 18 and older suffer from a serious mental illness, such as major depression, bipolar disorder, or schizophrenia.
Sources: National Institute of Mental Health, The Numbers Count; U.S. Census Bureau, State and County Quick Facts
104
BEHAVIORAL HEALTH Many of the Cobb County residents who receive treatment at the Cobb CSB have severe and persistent mental illnesses (SPMI) of at least two years duration, and that impair their daily life functioning. These mental illnesses include disorders such as major depression, schizophrenia, and bipolar disorder. Some persons treated by the Cobb CSB have mental disorders categorized as mood disorders and psychotic disorders.
Table 8-1 shows the prevalence estimates of mental disorder diagnoses for adults ages 18 years and older in the U.S. Table 8-1 Prevalence Estimates for Mental Disorders in U.S. Adults (18+) Type of Disorder
Estimated % of Population
Major Depression Any Mood Disorder Bipolar Disorder Schizophrenia Any Anxiety Disorder Generalized Anxiety Disorder
6.7% 9.5% 2.6% 1.1% 18.1% 3.1%
MOOD DISORDERS These include specific diagnoses such as major depression and bi-polar disorder. Among adults treated at the Cobb CSB during the period 2005-2008:
Mood disorder was the most frequently diagnosed disorder among adults ages 18 years and older. The frequency of mood disorder diagnosis varied among age groups, but was highest
among clients 55-64 years of age.
A diagnosis of mood disorder accounted for an average of 56% of all diagnoses among clients 55-64 years of age.
105
Cobb County Health Status Report, 2010
BEHAVIORAL HEALTH The Cobb CSB and Wellstar Health System partner to provide behavioral health services to adults incarcerated in the Cobb County Adult Detention Center.
Program data show that:
4,025 inmates received behavioral health services during FY 2009. The primary diagnoses categories among inmates are mood disorder and anxiety disorder. In May 2010, 25% of all inmates housed in the Cobb Detention Center were taking psychiatric medications.
MENTAL DISORDERS AMONG CHILDREN AND ADOLESCENTS Mental disorders commonly seen in children and adolescents are depression, attention-deficit/hyperactivity disorder (ADHD), adjustment disorder, and conduct disorder. Among children ages 5-17 receiving services from the Cobb CSB (2005-2008) approximately:
30% had attention deficit disorder 27% had a mood disorder
PSYCHOTIC DISORDERS Psychotic Disorders includes disorders such schizophrenia and schizoaffective disorder. These can occur in both children and adults. Schizophrenia affects men and women with equal frequency, but often first appears in men in their late teens or early twenties, while women are generally affected in their twenties or early thirties. Figure 8-2 shows the average frequency (by percentage of all diagnoses) of mood disorder or psychotic disorder among adults receiving services at the Cobb CSB during the period 2005-2008.
106
BEHAVIORAL HEALTH
The Cobb County CSB Stabilization Unit (SU) is a 16-bed crisis receiving facility that provides psychiatric stabilization and detoxification services to clients residing in Cobb and Douglas counties.
Data for the Stabilization Unit show that:
A total of 834 persons were admitted for treatment during FY 2009. Of these persons, 53% were treated for addictive diseases, and 47% were treated for mental disorders. Alcohol dependence is the most frequent disorder treated at the facility. Other drugs of abuse include prescription drugs and illicit drugs such as cocaine. Mood disorders accounted for 23% of all admission to the SU during the period 2005-2008. Some individuals are admitted to the unit with suicidal ideation (thoughts of suicide) which may result from other problems such as depression or drug use.
ADDICTIVE DISEASE The Cobb CSB provides addictive disease services for youth and adults through its outpatient services and residential programs. Additionally, the agency provides addiction services at the Stabilization Unit and within the criminal justice system.
107
Cobb County Health Status Report, 2010
BEHAVIORAL HEALTH
Data from Cobb CSB show that:
For the period 2005-2008, substance abuse diagnoses accounted for about 17% of all diagnoses among all age groups served by the Cobb CSB.
Addictive diseases appear more often among clients ages18-34 than among other age groups served by the Cobb CSB.
The majority of clients who receive services are seen for alcohol dependence.
Other drugs of abuse include opiates, cocaine, amphetamines, barbiturates, and marijuana.
During the period 2005-2008, approximately 13% of all persons treated for substance abuse at the Cobb CSB were poly substance abusers.
Some persons with addictions also have a co-occurring mental illness which complicates treatment outcomes. Among children and adolescents ages 5-17 receiving services from the Cobb CSB during the period 2005-2008:
Addictive disease disorders (alcohol and other drugs) accounted for an average of 11.5% of all diagnoses. Alcohol dependence/abuse accounted for an average of 6% of all substance abuse diagnoses. Cannabis (marijuana) abuse/dependence accounted for an average of 69% of all substance abuse diagnoses.
Some Risk Factors for Substance Abuse Among Youth
Early aggressive behavior Poor classroom behavior or social skills Academic failure A caregiver who abuses drugs Association with drug-abusing peers Lack of parental supervision Drug availability Major social transitions (i.e., beginning middle school or college)
108
WHY IS BEHAVIORAL HEALTH IMPORTANT?
Behavioral health is an integral part of overall health and well-being, not just for individuals, but for families and the community. Insight into the prevalence and impact of behavioral health issues within the county provides vital information to facilitate service planning and delivery. With proper treatment and support, those persons and families affected by mental or addictive disorders can be more fully integrated into the community and have opportunities to enjoy meaningful, fulfilling lives.
WHAT CAN YOU DO ABOUT IT?
Seek professional behavioral health services if you feel you need help. Develop a support network that includes family, friends, and community resources. Take care of your whole self. If you know someone who is suffering from a behavioral health issue, inform the individual that treatment services are available and recovery is possible. Treat persons who have behavioral health issues with respect and dignity.
TO LEARN MORE…. Georgia Department of Behavioral Health and Developmental Disabilities: www.dbhdd.georgia.gov
Substance Abuse and Mental Health Services Administration (SAMHSA): 1-877-726-4727, www.samhsa.gov
24-Crisis Line 1-800-715-4225
National Alliance on Mental Illness Georgia (NAMI): 770-234-0855, www.namiga.org
Cobb County Community Services Board www.cobbcsb.com
National Institute on Drug Abuse (NIDA): www.nida.nih.gov
Access Line 770-422-0202
109
Cobb County Health Status Report, 2010
COMMUNITY SAFETY Starting at birth, the entire population is at risk of injury or violence; however, the risks change as a person ages. Injuries and violence impacts not only the victim but can affect an entire family or community. Living in a violent neighborhood has been linked with increased substance abuse, high risk sexual behaviors and unsafe driving practices. Community safety impacts various other health factors and outcomes including birth weight, diet and exercise, and family and social support. (CDC)
CRIME ď&#x201A;ˇ ď&#x201A;ˇ
The violent crime rate for Cobb County in 2009 was 269.4 per 100,000 population; lower than both the Georgia rate of 410.6 and the national rate of 454.5. The rate for property crimes (including burglary, larceny, motor vehicle theft and arson) in Cobb County for 2009 was 2,084.4 per 100,000 population compared to the Georgia rate of 3,557.5 and the national rate of 3,214.5. (Cobb County rates were calculated using an estimated 2009 population of 705,231.)
From 2004-2008, larceny was the most frequently committed crime in Cobb County. Table 9-1: Crime Statistics Cobb County, 2004-2008. Murder Rape Robbery Assault Burglary Larceny 2008 2007 2006 2005 2004
18 36 25 64 18
114 130 130 294 174
859 1,096 923 1,326 754
1,055 1,120 1,098 1,899 1,009
4,533 4,604 4,160 7,103 4,311
11,288 12,350 12,201 23,194 13,146
Vehicle Theft 1,743 2,446 2,372 4,389 2,567
HOMICIDE Violence is a major public health problem in the United States. It affects people in all stages of life. In 2006, in the United States over 18,000 people were victims of homicide.
111
COMMUNITY SAFETY Homicide Facts
Age Adjusted Rate per 100,000 population
Figure 9-1: Mortality Rate due to Homicide, 2003-2007 8.1
9
7.8
7.3
8 7
6.9
6.8
6.7
6
5.8
5
4.6
4
3.9
3.5
3
Georgia
2 1 0 2003
2004
2005
2006
Cobb
2007
In Cobb County between 2003 -2007: ď&#x201A;ˇ The homicide rate in the back population was 9.7 per 100,000 population, almost 3 times higher than the white population which had a rate of 3.6. ď&#x201A;ˇ The age group with the highest homicide rate was the 20-29 year olds with a rate of 12.4 per 100,000 population.
GANG PARTICIPATION IN OUR SCHOOLS Gang participation figures for the 8th grade are highest; 8.4% of Marietta City students stated they had participated in a gang in the last 30 days which was higher than Georgia at 5.8%.
Figure 9-2: Percent of Students who Reported Gang Participation in the Past 30 Days by Grade, School Year 2009-10 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0
8.4
5.8 5.0
2.0 1.7
6th
112
5.9
5.6 4.5
2.5
4.3
Marietta City
2.5 1.7
8th
10th
Cobb County
Georgia
In Cobb County, Marietta City and Georgia, male students in Middle and High School are approximately twice as likely to participate in a gang as females.
12th
Cobb County Health Status Report, 2010
COMMUNITY SAFETY FAMILY VIOLENCE Family violence is a term in which one family member causes physical or emotional harm to another member of the family. It can include domestic violence, child and adult abuse. Family violence crosses all age, race, sex and socioeconomic groups. According to national studies, violence perpetrated by intimate partners is more severe than those perpetrated by strangers, resulting in more serious injuries and or death. Table 9-2: Number of Family Violence Incidents by Type of Abuse Cobb County, 2004-2008 Abuse Type
2004
2005
2006
2007
2008
Total
323
324
596
617
615
2475
Other Abuse
87
147
226
223
193
876
Abusive Language
33
63
171
243
144
654
Threats
60
77
111
117
103
468
Property Damage
35
47
77
102
83
344
Gun/Knife Wound
10
10
15
10
11
56
Sexual Abuse
5
7
8
6
4
30
Disabled (Permanent or Temporary)
1
3
7
7
6
24
Broken Bones Fatal Injury
0
2
2
4
5
13
1
0
2
4
0
7
Superficial Wounds
According to the 2009 Georgia Domestic Violence Fatality Review Annual Report, from 2003-2008 there were 37 fatalities caused by domestic violence in Cobb County. This was 5.2% of all Georgia deaths due to domestic violence.
CHILD MALTREATMENT Child maltreatment includes all types of abuse and neglect of a child under the age of 18. According to the CDC, child abuse is defined as words or overt actions that cause harm, potential harm, or threat of harm to a child. Child neglect is defined as the failure to provide for a child's basic physical, emotional, or educational needs or to protect a child from harm or potential harm. The types of child abuse include physical abuse, sexual abuse and psychological abuse.
th
In 2008, Cobb County ranked 19 lowest of the 158 counties reporting in Georgia for the rate of child abuse and or neglect.
Rate per 1,000 children under 18 Years
9-3: Rate of Substantiated Child Abuse and/or Neglect, 2003-2008 25
23.1 21.2
20
19.7
16.1
15
13.7 10.8
10 5
8.1
9.9
9.2
9.1
7.4
7.0
2007
2008
Cobb Georgia
0 2003
2004
2005
2006
113
COMMUNITY SAFETY INJURIES In Cobb County, injuries due to external causes account for 25.7% of all ED visits, and falls are the number one cause of ED visits due to injury.
Table 9-3: Number of Emergency Department Visits due to External Causes, 2003-2007 External Causes
2003
2004
2005
2006
2007
Total
10,620
10,674
10,791
10,740
10,276
53,101
Motor Vehicle Crashes
6,862
7,070
7,132
6,766
6,116
33,946
Homicide
1,237
1,304
1,332
1,284
1,297
6,454
Poisoning
470
490
467
542
479
2,448
Suicide
392
370
406
361
351
1,880
Fire and Smoke Exposure
132
113
106
101
84
536
Accidental Shooting
39
37
59
82
45
262
Legal Intervention
45
38
27
31
46
187
Drowning
11
15
16
12
16
70
42,673
42,708
41,710
40,476
37,842
205,409
Falls
Total
From 2003-2007 the rate of Ed visits for falls was highest in the elderly, over age 75, with a rate of 5,157.10 per 100,000 visits compared to an overall rate of 1,589.80 for all age groups.
MOTOR VEHICLE CRASHES (MVC) The mortality rate for motor vehicle crashes (MVCs) in Cobb County is lower than Georgiaâ&#x20AC;&#x2122;s rate. However, MVCs still account for a large number of deaths in the county.
114
Cobb County Health Status Report, 2010
COMMUNITY SAFETY MVC FACTS
From 2002-2004, half of the 10 most crash-prone intersections in the region were in Cobb County. Several of these intersections have been improved or are scheduled for safety improvements in the near future. These intersections are: Austell Road at EastWest Connector (477 crashes), Barrett Parkway at Cobb Place Boulevard (377), Cobb Parkway at Barrett Parkway (376) Chastain Road at Busbee Parkway (296) and Austell Road at South Cobb Drive (263).
20.0 Age Adjusted Rate per 100,000
In 2008, Cobb County ranked 2nd highest out of the 159 counties in Georgia for the number of crash fatalities. In the 18 county metropolitan Atlanta region, 45% of all motor vehicle crashes each year occur at intersections
18.0
16.2
17.2
18.0
17.5
17.7
16.0 14.0
12.2 10.9
12.0
10.9
10.0
Cobb
8.0 5.1
6.0
Georgia
5.8
4.0 2.0 0.0 2003
2004
2005
2006
2007
Age is a significant risk factor in fatalities due to motor vehicle crashes. According to the CDC, teen drivers ages 16 to 19 are 4 times more likely than older drivers to get in an accident. In Cobb County in 2006 the rate of crashes to drivers ages 18 to 20 was the highest with a rate of 16,732.3 per 100,000 licensed drivers compared to 5,413.1 for those over the age of 24. Additionally, motor vehicle crash deaths increase significantly starting at age 75. Figure 9-5: Mortality Rates by Age due to Motor Vehicle Crashes, 2003-2007 Rate per 100,000 population
Figure 9-4: Mortality Rate due to Motor Vehicle Crashes, 2003-2007
Cobb
Georgia
40 15.8
20 10
30.8
25.8
30
4.4
9.4
17.5
17.4
8.8
6.9
30-44
45-59
19.5
20.9
10.5
0 0-19
20-29
60-74
75+
115
COMMUNITY SAFETY Table 9-4: Fatalities by Person/Crash Type in Cobb County, 2004-2008 2004 2005 2006 2007 2008 Total Fatalities (All Crashes)* 62 71 65 59 67 Alcohol Impaired (BAC=.08+)* 14 13 17 14 18 Speeding Involved 12 17 13 10 19 Intersection Related 14 26 11 14 24 Motorcyclist Fatality 5 3 11 10 11 Pedestrian Fatality 12 10 14 10 7 Bicyclist (or other cyclist) 1 1 1 0 1
Total 324 76 71 89 40 53 4
*Fatalities can be in more than one category.
Cobb County Crash Facts
116
ď&#x201A;ˇ
Of Cobb County crashes in 2006, 90.2% of individuals over age 5 were wearing seat belts; in crashes with fatalities, 52.7% were unrestrained.
ď&#x201A;ˇ
In 2008, 95.3% of individuals under the age of 6 were restrained using a car seat in Cobb County crashes (Restraint use was unknown in 1.7% of crashes.)
Cobb County Health Status Report, 2010
WHY ARE MOTOR VEHICLE CRASHES IMPORTANT?
Motor vehicle crashes are a leading cause of death for people ages 1-34 in the U.S. and it is estimated that approximately 5 million people sustain injuries that require an emergency department visit.
WHAT CAN YOU DO ABOUT IT? Common Driving Distractions
Don’t be a distracted driver.
Always wear your seatbelt. Properly restrain children while in a vehicle. Car seat inspections and education is available through Safe Kids Cobb County, a program offered through a partnership between Cobb & Douglas Public Health and the Wellstar Health System. Contact Safe Kids Cobb County at (770)514-2369 to set up a car seat inspection appointment. An infant or child should be in a car safety seat until at least 4 year/40lbs. After they reach 4 years/40 lbs, they should use a booster seat until they are 4’9’’/80-100 lbs (normally 9-10 years of age). Do not consume alcohol and drive. Turn on headlights when it’s raining. Obey all traffic laws. Don’t go above the speed limit.
cell phone use & texting adjusting your radio, CD player or GPS reading eating or drinking
taking off your coat or jacket putting on makeup, combing hair listening to music too loudly smoking
Did you know… Crash forces double on impact with every 10 mph increase in speed above 50 mph
Children not restrained in a child safety seat during a crash are 3 times more likely to be injured.
The misuse rate for child safety seats is 80 – 85%. Learn to properly install and use your car seat.
117
WHY ARE MOTOR VEHICLE CRASHES IMPORTANT?
HOW DO WE COMPARE? In 2008, Cobb County ranked 2nd highest out of the 159 counties in Georgia for the number of crash fatalities. In the 18 county metropolitan Atlanta region, 45% of all motor vehicle crashes each year occur at intersections. From 2002-2004, half of the 10 most crash-prone intersections in the region were in Cobb County.
TO LEARN MORE….. Websites www.safekidscobbcounty.org www.NHTSA.gov
Phone Numbers Safe Kids Cobb County (770) 852-3258 Governor’s Office of Highway Safety (404) 656-6996
www.gahighwaysafety.org www.carseat.org
118
Cobb County Health Status Report, 2010
COMMUNITY SAFETY SUICIDE Suicide occurs when a person ends their life. It is the 11th leading cause of death among Americans. More than 33,000 people kill themselves each year. More than 395,000 people with self-inflicted injuries are treated in emergency departments each year. Suicide affects everyone, but some groups are at higher risk than others. Men are 4 times more likely than women to die from suicide. However, 3 times more women than men report attempting suicide. In addition, suicide rates are high among middle aged and older adults. (CDC, 2009) The suicide rate in Cobb County from 2003-2007 was much higher in whites with a rate of 10.2 per 100,000 compared to a rate of 5.7 for Blacks
Age Adjusted Rate per 100,000 population
Figure 9-6: Mortality Rate due to Suicide, 2003-2007 12.0
11.4
11.2 10.1
10.0 8.0
9.4
Table 9-7: Percent of Students Reporting a Suicide Attempt by Gender, School Year 2009-10
9.8
9.7
School System
9.4 8.3
7.7
6.0
10.4
Cobb Georgia
4.0
Cobb County Schools Marietta City Schools
2.0 0.0 2003
2004
2005
2006
2007
Georgia
Gender Female
Yes 4.8%
Male
2.0%
Female
5.7%
Male
4.6%
Females
5.2%
Males
4.3%
If you or someone you know is thinking about suicide, contact the National Suicide Prevention Lifeline at
1-800-273-TALK (1-800-273-8255).
119
COMMUNITY SAFETY EMERGENCY PREPAREDNESS AND RESPONSE Cobb and Douglas Public Health (CDPH) conduct emergency preparedness planning, training, exercising and response to all hazard emergency events which have the potential to affect the entire population. Recent events that required public health emergency response in Cobb County include the 2009 Flood, the H1N1 pandemic, and the receiving of Haitian earthquake victims through activation of the National Disaster Medical System (NDMS) activation. CDPHâ&#x20AC;&#x2122;s Center for Emergency Preparedness and Response may be contacted at 770-514-2330.
120
Cobb County Health Status Report, 2010
E NVIRONMENTAL H EALTH ENVIRONMENTAL HEALTH The environment plays an important role in human development and health. People born today have a life expectancy about twice that of people born a century ago. The National Institute of Environmental Health Sciences attributes most of these additional years to healthful environmental changes such as improved sanitation, purified water, cleaner air and the safer use of chemicals. Hippocrates, the Father of Medicine said, “If you want to learn about the health of the population, look at the air they breathe, the water they drink, and the places where they live.”
CDPH’s Center for Environmental Health administers the following environmental health services in the county:
Planning the review, permitting, inspection and complaint investigation of: Food service establishments Public swimming pools Tourist accommodations Mobile home parks On-site sewage management systems and pumper operations Investigation of foodborne, waterborne and vectorborne diseases Food safety training and certification Investigation of general nuisance complaints concerning sewage, insects, rodents, solid wastes, indoor air quality and other environmental issues On-site sewage contractor testing and certification Inspection and sampling of individual water wells West Nile virus surveillance, technical assistance and complaint investigation Radon education and testing Childhood Lead Poisoning Prevention Program
122
ENVIRONMENTAL HEALTH AIR QUALITY Federal and state standards are set for air quality. These standards define levels of quality that are necessary, with an adequate margin of safety, to protect the public from known or anticipated harmful effects of pollutants. The Georgia Environmental Protection Division (EPD) monitors air quality year-round on pollutants with the exception of ozone, which is measured March through November. The Air Quality Index (AQI) converts the measured pollutant concentration in a communityâ&#x20AC;&#x2122;s air to a number on a scale of 0 to 500. A pollutant reading is in the unsatisfactory range if it exceeds 100. Cobb County AQI is part of the Metropolitan Atlanta AQI. You may access air quality on any given day at www.georgiaepd.org.
In 2009, Metropolitan Atlanta (which includes Cobb County) air quality measured in the unhealthy range 16 out of 340 days measured.
OZONE The air quality standard for ozone, which is designed to protect public health with an adequate margin of safety, is established by the United States Environmental Protection Agency (EPA). In 2008, EPA revised the 8-hour average ozone standard to lower the thresholds for ozone levels reported as 'unhealthy'. The air quality standard for ozone is 0.075 parts per million (ppm), averaged over eight hours. According to the EPA ground-level ozone, a primary component of smog, is one of the major air pollution problems in the United States. Ozone is measured March through November at 24 sites across Georgia, one of which is in Kennesaw. In 2009, there were 14 days in metropolitan Atlanta where the ozone level exceeded standards set by the EPA. You may access ozone levels on any given day by going to www.georgiaepd.org.
123
Cobb County Health Status Report, 2010
E NVIRONMENTAL H EALTH ENVIRONMENTAL HEALTH WATER QUALITY Cobb County receives its drinking water from the Cobb CountyMarietta Water Authority, a regional wholesale provider. Cobb’s drinking water originates entirely in Georgia and is delivered to residents by the Cobb County Water System. The System is an award winning provider that has been nationally and locally recognized for excellence in water systems. Drinking water, including bottled water, may reasonably be expected to contain at least small amounts of some contaminants. The presence of contaminants does not necessarily indicate that water poses a health risk. Contaminants that may be present include microbial, inorganic, pesticides, herbicides, organic and radioactive. More information about contaminants and potential health effects can be obtained by calling the EPA’s Safe Drinking Water Hotline at 1- 800-426-4791.
People more vulnerable to contaminants in drinking include:
Immuno-compromised persons, such as persons with cancer undergoing chemotherapy, persons who have undergone organ transplants, people with HIV/AIDS or other immune system disorders Some elderly people Infants
Each year the Cobb County Water System publishes an annual water quality report. You may access the current and past reports by going to www.cobbwater.org.
The Cobb County Water System reported that in 2009 drinking water met or exceeded all safety and quality standards set by the State of Georgia and the EPA.
124
ENVIRONMENTAL HEALTH HAZARDOUS WASTE SITES The Hazardous Site Inventory (HSI) is a list of sites in Georgia where there has been a known or suspected release of a regulated substance above a reportable quantity; and which have yet to show they meet state clean-up standards found in the Rules for Hazardous Site Response. The HSI is compiled and published by the Georgia Environmental Protection Division (EPD) annually. The July 1, 2008 edition listed 575 sites, and the July 1, 2009 edition added 9 sites and removed 11 for a total of 573 sites for Georgia. In 2009, 27 sites were identified in Cobb County. The following map shows the location of these sites.
Additional information regarding the Hazardous Sites Response Program, the rules for Hazardous Site Response, or an electronic version of the HSI can be found on the Georgia Environmental Protection Division web site at www.gaepd.org. If you would like more information about a site listed on the map, please contact the Hazardous Sites Response Program at 404-657-8600.
125
Cobb County Health Status Report, 2010
E NVIRONMENTAL H EALTH ENVIRONMENTAL HEALTH RABIES Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. Death usually occurs within days of the onset of symptoms. Table 10-1 provided by the CDC shows the likelihood of occurrence of rabies in different animals.
Frequently Raccoons Foxes Bats Skunks
Table 10-1: Occurrence of Rabies in Animals Occasionally Dogs* Cats*
Rarely Rabbits Rodents Hares Livestock
* Unvaccinated Table 10-2 shows that even though the greatest number of rabies tests are done on dogs and cats, raccoons are the most likely to test positive in Cobb County. In fact, half of the raccoons tested in 2009 were positive. People are often exposed to rabid raccoons because they try to feed and handle them. Raccoons are wild animals that should never be domesticated. Table 10-2: Types of Animals Tested Cobb County, 2009 Animal How many Tested were tested Positive Cat 58 1 Dog
77
0
Bat
14
1
Fox
2
1
Raccoon
22
10
Chipmunk
1
0
Squirrel
1
0
Hamster
1
0
From 2003-2009 there was an average of 12 rabid animals per year identified in Cobb County.
126
WHY IS RABIES IMPORTANT?
Rabies is caused by a virus that infects the central nervous system, ultimately causing disease in the brain and death in mammals (animals and humans). The virus is most often transmitted by the bite or scratch of an infected animal. It is one of the most deadly viruses known causing death in almost 100% of mammals.
WHAT CAN YOU DO ABOUT IT? 1. 2. 3. 4. 5.
Keep rabies vaccinations up-to-date for all cats, ferrets and dogs. Maintain control of your pet by keeping them under direct supervision. Spay or neuter your pets to prevent roaming and contact with rabid mammals. Do not feed or try to domesticate wild animals like raccoons. Do not touch stray animals; and call Cobb County Animal Control to remove all stray animals from your neighborhood. Contact information for Animal Control is www.animalcontrol.cobbcountyga.gov or 770- 499-4136.
6. If you are bitten or scratched by an animal: 7. Wash the wound 8. Seek medical treatment if needed 9. Report the incident to Cobb County Animal Control
HOW DO WE COMPARE?
Rabies occurs in every state of the United States except Hawaii. More than 90% of all animal cases reported annually now occur in wildlife. Most of the rabies cases occur in raccoons, although rabid bats are becoming prevalent. Georgia averages around 336 rabies cases per year. Cobb County averages 12 rabies cases per year. 27 cases of human rabies have been reported in people in the United States since 1970. A human case of rabies was last reported in Georgia in 2000.
TO LEARN MORE… For more information, log onto the following websites. www.cdc.gov/rabies www.health.state.ga.us
127
Cobb County Health Status Report, 2010
E NVIRONMENTAL H EALTH ENVIRONMENTAL HEALTH VECTOR-BORNE DISEASES Diseases that are carried by arthropods such as mosquitoes and ticks are called vector-borne diseases. West Nile virus (WNV) is a potentially serious vector-borne illness that appeared in the eastern United States in 1999. Most often, WNV is spread by the bite of an infected mosquito. Mosquitoes become infected when they feed on infected birds. Infected mosquitoes can then spread WNV to humans and other animals when they bite.
Did you know… The Cobb & Douglas Public Health (CDPH) Epidemiology Team interviews reported human cases of WNV. These interviews provide valuable epidemiological data as well as education to infected residents. The CDPH Environmental Health staff work in conjunction with the Cobb County Water Authority to place larvicide in standing water throughout the county. Larvicide kills mosquito larvae before they become biting adults. Residents may call the CDPH Environmental Health Program to report mosquito complaints at 770-435-7815.
Important facts about WNV include:
1 in 150 people infected with the virus develop severe illness including paralysis.
4 out of 5 people who are infected with the virus never show any symptoms and do not seek medical care.
10 confirmed human WNV cases were confirmed in Cobb County from 2005-2009.
WHAT CAN YOU DO TO PREVENT WNV? The best way to avoid WNV is to prevent mosquito bites.
Use insect repellent containing DEET, Picaridin, Oil of Lemon Eucalyptus (or PMD), or IR3535. Pregnant women should contact their health care provider before using repellent. Avoid outdoor activities at dawn and dusk when mosquitoes are most active. Make sure you have good screens on your windows and doors to keep mosquitoes out. Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Keep children's wading pools empty and on their sides when not in use.
128
IMPROVING OUR COMMUNITY M.A.P.P. MAPP is a community-wide strategic planning tool for improving public health. A method to help communities prioritize public health issues, identify resources for addressing them, and take action.
When people with different points of view come together they develop better, more comprehensive and more creative solutions to problems. MAPP serves as a tool for bringing together diverse segments of the community. When ownership of the problems and solutions includes a broad base of the community, the effort is sustainable, actions build on collective wisdom, and resources from throughout the community contribute to health improvement.
We hope the information in this report provided you with valuable knowledge regarding the health of Cobb county – the community in which we live, work and play. We all have a responsibility and must work together to make ourselves, our families, our neighborhoods, and our county healthy. In 2011, Cobb County will begin a very important process called MAPP (Mobilizing for Action through Planning and Partnerships). MAPP is a community-wide strategic planning process for improving our community’s health. In this context, we broadly think of “health” as a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity. (World Health Organization, 1998) Although Cobb & Douglas Public Health leadership will facilitate the MAPP process, participation and ownership will be spread throughout the community. It is a community-driven process that will engage and seek active participation from schools, faith-based organizations, local business, local government, hospitals, physicians, behavioral health services, philanthropists, foundations, parks & recreation services, mass transit, police, fire, EMS, employers, and civic groups… just to name a few! Broad community participation is essential because a wide range of organizations and individuals contribute to our community’s health. Through MAPP, a broad collection of system partners and community residents will come together to: Prioritize public health issues Identify resources for addressing them, and Take action! The model below shows how the MAPP process works – the phases of MAPP are shown along a road that leads to “A Healthier Cobb.”
To Learn More about the upcoming MAPP process and/or to express an interest in participating, please visit our website@ www.cobbanddouglaspublichealth.org
Model provided by NACCHO (National Association of County and City Health Officials)
APPENDIX List of Tables and Figures
Profile of Our County Figure 2-1 Figure 2-2 Table 2-1 Figure 2-3 Figure 2-4 Table 2-2 Figure 2-5 Figure 2-6 Figure 2-7 Table 2-3 Table 2-4 Figure 2-8 Figure 2-9
General Health of Cobb County Residents, 2001, 2006-08 Racial Distribution Cobb County, 2003-08 Language Spoken at Home by Household Cobb County, 2006-08 Hispanic Population Cobb County, 2003-08 Age Distribution Cobb County, 2008 Household Profile Cobb County, 2003-08 Children's (<18 yrs) Relationship to Householder Cobb County, 2003-08 Household Income Cobb County, 2006-08 Unemployment Rates, 2004-09 Poverty, 2006-08 Homeless Population and Shelter Beds, 2009 Educational Attainment for the Population>25 yrs old Cobb County, 2006-08 Graduation Rates by School System
9 10 11 11 12 13 14 15 16 17 18 19 20
Access to Healthcare Table 3-1 Table 3-2 Table 3-3 Table 3-4 Figure 3-1 Figure 3-2 Table 3-5 Figure 3-3
Percent of Adult Residents Who Visited a Dentist, 2008 Healthcare Facilities Cobb County, 2008 Uninsured Residents Cobb County, 2008 Medicaid Member Average and Payment, 2008 Medicaid Members by Race and Ethnicity Cobb County, 2008 Percent Medicaid Member by Race Cobb County, 2008 PeachCare for Kids Member Average and Payment, 2008 Peachcare Members by Race and Ethnicity Cobb County, 2008
24 24 25 26 26 26 27 27
Leading Causes Table 4-1 Figure 4-1 Table 4-2 Figure 4-2 Table 4-3 Figure 4-3
Leading Causes of Mortality Leading Causes of Mortality by Race Cobb County, 2003-07 Leading Causes of Premature Death Cobb County, 2003-07 Leading Causes of Hospitalization Cobb County, 2003-07 Age Adjusted Mortality Rate per 100,000 population (2003-2007) Leading Causes of Mortality (Age Adjusted) Cobb County, 2003-07
30 30 31 31 32 32
Chronic Disease Figure 5-1 Table 5-1 Table 5-2 Figure 5-2 Figure 5-3 Table 5-3 Figure 5-4 Table 5-4 Table 5-5 Figure 5-5 Figure 5-6
132
Mortality Rate due to Cardiovascular Diseases, 2003-2007 Percent of Adults who report CVD Conditions Cobb County, 2007 & 2008 Percent of Adult Residents who received Routine Medical Screenings, 2007 Mortality Rates due to Cardiovascular Disease by Type and Race , 2003-2007 Percent of Adults Ever Told They Had a Heart Attack Cobb County, 2007-2008 Age Adjusted Mortality Rates* due to Leading Causes of Cancer by Gender, 2003-2007 Mortality Rate due to Cancer, 2003-2007 Leading Causes of Cancer Incidence (New Cases) by Gender and Race Cobb County, 2003-2007 Percent of Adult Residents Reporting Routine Preventative Cancer Screenings, 2008 Cancer Cases by Stage of Diagnosis , 2003-2007 Breast Cancer Cases by Stage of Diagnosis Cobb County, 2003-2007
35 36 36 36 37 40 40 41 42 42 43
APPENDIX List of Tables and Figures
Chronic Disease (continue) Figure Figure Figure Figure Figure Figure
5-7 5-8 5-9 5-10 5-11 5-12
Figure 5-13 Figure 5-14 Figure Figure Figure Figure Figure Figure
5-15 5-16 5-17 5-18 5-19 5-20
Figure 5-21 Figure 5-22
Emergency Department Visits for Asthma by Age Groups Cobb County, 2003-2007 Percent of Adult Who Have Been Told They Currently Have Asthma 2002, 2006-2008 Mortality Rate due to Diabetes, 2003-2007 Percent of Adults Ever Told They Are Diabetic, 2006-2008 Percent of Adult Females Ever Told They Have Pregnancy Related Diabetes, 2006-2008 Mortality Rate due to Chronic Obstructive Pulmonary Disease (COPD), 2003-2007 Percent of Adults Classified as Heavy Drinkers* 2002, 2006-2008 Percent of Adults Who Have Had at Least One Alcoholic Drink within the Last Thirty Days 2002, 2006 - 2008 Percent of Adults who Binge Drink*, 2006 - 2008 Mortality Rates due to Alcoholic Liver Disease, 2003-2007 Percent of Adult Population Who Are Current Smokers, 2002 , 2006- 2008 Smoking Status of Adults Cobb County, 2008 Percent of Adults who are Overweight by BMI, 2002, 2006 - 2008 Percent of Adults who are Obese by BMI, 2002, 2006 - 2008 Percent of Adults Who Have Not Participated in Any Physical Activity During the Past Month, 2002, 2006 - 2008 Percent of Adults who Consume More Than 5 Fruit or Vegetables Daily, 2002 & 2007
46 46 50 50 51 54 55 55 56 56 57 57 60 60 61 61
Infectious Disease (continue) Figure 6-1 Figure 6-2 Figure 6-3 Figure 6-4 Figure 6-5 Figure 6-6 Figure 6-7 Figure 6-8 Figure 6-9 Figure 6-10 Table 6-1 Figure 6-11 Figure 6-12 Figure 6-13 Table 6-2 Table 6-3 Figure 6-14
Chlamydia Rate, 2003-2008 Chlamydia Rate by Age Group, 2003-2009 Gonorrhea Rate, 2003-2008 Gonorrhea Rate by Age Group, 2003-2009 Primary and Secondary Syphillis Rate, 2003-2008 Primary and Secondary Syphilis Rate by Age Group, 2003-2008 Newly Diagnosed HIV/AIDS Cases by Year Cobb County, 1992-2008 Persons Living with HIV/AIDS by Age Group Cobb County, 2008 Persons Living with HIV/AIDS by Transmission Category Cobb County, 2008 Tuberculosis Cases Cobb County, 2003-2009 The ABCs of Hepatitis Percent Influenza-Like-Illness Cases to Network Providers by Month, 2009 Hospitalizations for Confirmed H1N1 by Age Group Cobb County, 2009 Hospitalizations due to Pneumonia, 2003-2007 Vaccine-Preventable Diseases (Cases) Cobb County, 2003-2009 Cases of Invasive Bacterial Diseases, 2003-2008 Gastrointestinal Diseases Cobb County, 2003-2009
64 64 66 66 67 67 68 68 69 72 74 75 76 77 78 79 80
Maternal & Child Health Figure 7-1 Figure 7-2 Table 7-1 Figure 7-3
Pregnancy Rates by Age Group Cobb County, 2003-2007 Pregnancy Rate by Race/Ethnicity Cobb County, 2003-2007 Repeat Teen Births Cobb County, 2008 Teen (15-19 years old) Pregnancy Rate by Race\Ethnicity Cobb County, 2003-2007
85 86 87 87 133
APPENDIX List of Tables and Figures Maternal & Child Health (continue) Figure 7-4 Figure 7-5 Figure 7-6 Figure 7-7 Table 7-2 Figure 7-8 Table 7-3 Figure 7-9 Table 7-4 Table 7-5 Figure 7-10 Figure 7-11 Figure 7-12 Figure 7-13
Percent of Births with Inadquate* Prenatal Care Cobb County, 2002-2006 Induced Terminations, 1998-2007 Infant Mortality, 2003-2007 Infant Mortality by Race/Ethnicity Cobb County, 2003-2007 Top Causes of Infant Deaths Cobb County, 1998-2007 Percent of Low Birth Weight Babies by Race/Ethnicity Cobb County, 2003-2007 Leading Causes of Emergency Department (ED) Visits in Children 1-19 Years of Age in Cobb County, 2003-2007 Percent of Mothers who Reported Ever Breastfeeding their Infant in Georgia, 2004-2006 Percent of Children Receiving Immunizations On Schedule by Study Year District 3-1, 2004-2008 Average Age of Onset Use of Alcohol, School Year 2009-10 Percent of Students who Reported Alcohol Use in the Past 30 days by School Year 2008-09 through 2009-10 Percent of Students who Reported Binge Drinking in the Past 30 days by School Year 2007-08 through 2009-10 Percent of Students Who Reported Yes to Tobacco Use Within the Past 30 Days, 2008-2009 Percent of Students who Report Using Chewing Tobacco in the Past 30 Days School Year 200708 through 2009-10
88 88 89 89 90 90 93 93 94 99 99 100 101 101
Behavioral Health Figure 8-1 Table 8-1 Figure 8-2
Types of Services Provided by Cobb CSB Prevalence Estimates for Mental Disorders in U.S. Adults (18+) Percent of Mood & Psychiatric Disorder Diagnoses, 2005-08
103 105 106
Community Health Table 9-1 Figure 9-1 Figure 9-2 Table 9-2 Figure 9-3 Table 9-3 Figure 9-4 Figure 9-5 Table 9-4 Table 9-5 Figure 9-6
Crime Statistics Cobb County, 2004-09 Mortality Rates due to Homicide, 2003-07 Percent of Students Who Reported Gang Participation 2009-10 Number of Family Violence Incidents by Type of Abuse Cobb County, 2004-2008 Rate of Substantiated Child Abuse and/or Neglect, 2003-2008 Number of Emergency Department Visits due to External Causes, 2003-2007 Mortality Rate due to Motor Vehicle Crashes, 2003-2007 Mortality Rates by Age due to Motor Vehicle Crashes, 2003-2007 Fatalities by Person/Crash Type in Cobb County , 2004-2008 Percent of Students Reporting a Suicide Attempt by Gender, School Year 2009-10 Mortality Rate due to Suicide, 2003-2007
111 112 112 113 113 114 115 115 116 119 119
Environmental Health Table 10-1 Table 10-2
134
Occurrence of Rabies in Animals Types of Animals Tested Cobb County, 2009
126 126
APPENDIX
135
APPENDIX Programs & Services
Adolescent Health & Youth Development (AHYD)
Babies Born Healthy
Body Arts
Description Provides health & sexuality education and positive youth development opportunities designed to reduce risky behaviors among adolescents 10-19 years of age through education, health services and community partnerships.
Agnes F. Brown Director, AHYD (678) 385-1371 l (678) 385-1376 (fax) afbrown@dhr.state.ga.us
Offers prenatal services at a discount through participating obstetric offices to help reduce infant mortality; also may offer some financial assistance towards this care.
Rose Bishop, RN, PHN Supervisor, Family Support Pregnancy Services (770) 514-2376 (678) 354-0751 (fax) robishop@dhr.state.ga.us Pat Koffman Environmental Health County Manager (770) 438-5101 plkoffma@dhr.state.ga.us Cheri Holden, RN BTM Coordinator (770) 514-2321 cjholden@dhr.state.ga.us
Develops and enforces safety standards for tattoo parlors.
Provides access to timely breast and cervical cancer screening and Breast & Cervical Cancer diagnostic services for low-income, Prevention uninsured, and underserved women.
Child Health
Children 1st
Children's Medical Services
136
Contact Information
Provides health care services to lowincome or uninsured children through health checks, mental assessments, and developmental evaluations. Provides Pediatric Primary Care at key locations.
Deborah S. Heaton, RN District Director, Child Health, School Health, & Dental Health (770) 514-2339 (770) 514-2414 (fax) dsheaton@dhr.state.ga.us
Increases access to health care for children, identifies medical/developmental issues in children, and links them to necessary services as soon as identified.
Kathy Woods, RN Supervisor, Cobb County Family Support (770) 514-2404 (678) 354-0751 (fax) kdwoods@dhr.state.ga.us
Helps coordinate a comprehensive system of healthcare for children and youth from birth to twenty-one years of age who have eligible chronic medical conditions, which may include special needs caused by medical, behavioral, developmental, learning or mental health factors.
Carol VanderPlate, RN, C. CMS Supervisor (770) 432-0112 x-2121 (770)432-1774 (fax) clvanderplate@dhr.state.ga.us
APPENDIX Programs & Services
Chronic Disease Prevention
Early Intervention Babies Can't Wait
Description Implements programs and services aimed at reducing disease risks by targeting unhealthy behaviors, providing access to early detection and treatment, and improving management to reduce the burden of diabetes, obesity, asthma, cardiovascular disease, and tobacco abuse. Serves as an early intercession system for the families of special-needs infants and toddlers, ages birth to 3 years old.
Conducts preparedness planning, training, exercising and response to Emergency all hazard emergency events which Preparedness & have the potential to affect the entire Response population. Follows up on reports of notifiable illnesses in the district; conducts Epidemiology & Disease contact investigation and, when appropriate, provides medication to Surveillance those contacts at risk.
Family Planning
Food Service
High Risk Infant Follow-Up
Provides education and services to help reduce unintended pregnancies, to improve birth outcomes through preconceptual health promotion, and to promote the health of mothers by providing basic reproductive health care to women in need. Enforces local and state food service regulations for over 2,100+ establishments in order to prevent the occurrence of foodborne illnesses and to ensure a standard level of food safety in retail and institutional food facilities. Provides services to infants, birth to age one, who are at increased risk for health and developmental problems due to their medical conditions at birth.
Contact Information Cathy Wendholt-McDade District Health Promotion Director (770) 432-1980 (770) 432-1774 (fax) cwmcdade@dhr.state.ga.us
Beth Mathison, M.Ed Children and Youth with Special Needs District Director (770) 514-2462 (770) 514-2803 (fax) bymathison@dhr.state.ga.us Pam Blackwell, RN Director, Emergency Preparedness & Response 770-514-2330 psblackw@dhr.state.ga.us Joy Wells, M.P.H. Director for Epidemiology and Infectious Diseases (770) 514-2747 (770) 514-2313 (fax) joywells@dhr.state.ga.us Patti Duckworth, RN, DNP, APRN, BC Director, Clinical Nursing Services (770) 514-2496 (770) 514-2414 pgduckwo@dhr.state.ga.us
Karen Gulley Environmental Health County Manager (678) 385-5066 khgulley@dhr.state.ga.us
Kathy Woods, RN Supervisor, Cobb County Family Support (770) 514-2404 (678) 354-0751 (fax) kdwoods@dhr.state.ga.us
137
APPENDIX Programs & Services
HIV
Immunizations
Injury Prevention/Safe Kids
International Travel Health
Jail Inmate Clinical Services
Nuisance Complaints
Nutrition Services
138
Description
Contact Information
Provides comprehensive primary care services to persons infected with HIV/AIDS; services include primary care, case management, nutrition, AIDS Drug Assistance Program (ADAP), adherence counseling, and mental health counseling.
Joy Wells, M.P.H. Director for Epidemiology and Infectious Diseases (770) 514-2747 (770) 514-2313 (fax) joywells@dhr.state.ga.us
Works to ensure that children, adolescents, and adults are up to date on their immunizations so that vaccine-preventable diseases are minimized.
Karen Thomas, RN District Immunization Director (770) 514-2349 (770) 428-3855 (fax) kdibling@dhr.state.ga.us
Works to reduce the number of accidental injuries to children ages 14 and under through community partnerships, advocacy, public awareness and education, and the distribution of safety equipment. Safe Kids provides prevention programs in the following risk areas: Car seat inspections and education, pedestrian safety, wheeled sports (bicycle, scooter, skateboard) safety, home safety, poison prevention, and water safety. Provides health consultations & vaccines to persons traveling out of the country; provides malaria prophylaxis to persons traveling to areas where risk of acquiring malaria is great.
Amanda J. Walpole, CHES, MPH, CPSTI Safe Kids Cobb County Coordinator (770) 852-3285 (770) 852-3290 (fax) ajwalpole@dhr.state.ga.us www.safekidscobbcounty.org
Karen Thomas, RN District Immunization Director (770) 514-2349 (770) 428-3855 (fax) kdibling@dhr.state.ga.us
Provides medical care to inmates of the Cobb Lorrie Tate, R.N County Adult Detention Center Public Health Nurse Coordinator (678) 355-7072 lstate@dhr.state.ga.us Investigates and takes action to abate public Pat Koffman health nuisances related to on-site sewage Environmental Health County Manager management system failure, vector control, (770) 438-5101 sewage leaks, refuse removal, and other plkoffma@dhr.state.ga.us potential health threats.
Licensed and registered clinical dietitians provide individual and group nutritional counseling. Topics may include weight management, food allergies, diabetes, pregnancy-related concerns, heart disease, high cholesterol and high blood pressure.
Cathy Wendholt-McDade District Health Promotion Director (770) 432-1980 (770) 432-1774 (fax) cwmcdade@dhr.state.ga.us
APPENDIX Programs & Services
Onsite Sewage Management Systems
Oral Health/Dental
Perinatal Case Management
Pharmacy Services
Private Water Systems
Public Swimming Pools
Radon Follow-Up
School Health
Description
Contact Information
Provides ongoing surveillance to ensure proper installation and functioning of onsite sewage management systems, helping more than 50,000 households and businesses effectively treat and dispose of liquid waste.
Pat Koffman Environmental Health County Manager (770) 438-5101 plkoffma@dhr.state.ga.us
Conducts dental screenings and provides dental services for children ages 2 to 20, including composite fillings, sealants, cleanings, fluoride treatments, stainless steel crowns, pulpotomies, and extractions; provides dental health education in the community. Encourages early prenatal care by reducing the barriers to getting medical care, assisting with the Medicaid process, and providing healthy pregnancy education and community referrals.
Penny H. Madderra, RDH District Dental Manager (770) 514-2373 phmadderra@dhr.state.ga.us
Provides a large formulary of low cost medications related to our clinical programs, such as Pediatric Primary Care, Family Planning, Sexually Transmitted Infections, HIV and other programs. We also provide Pharmacy services to low income clients of several area medical clinics.
Jeff McGhee, RPh Pharmacy Director (770) 514-2345 jbmcghee@dhr.state.ga.us
Assures the proper location of wells and encourage the routine testing of well water to prevent the transmission of waterborne diseases to individuals that consume well water. Enforces a local, comprehensive swimming pool regulation to address the 1,300 public swimming pools that are operated within the health district. Educates the public concerning health risks associated with radon; provides radon testing and mitigation resources.
Pat Koffman Environmental Health County Manager (770) 438-5101 plkoffma@dhr.state.ga.us
Provide support and guidance to district School Health nurses; Coordinates and conducts scoliosis, hearing, vision & dental screenings and referrals; Provides the first line access of health care available to nonMedicaid or low-income, uninsured children in the Marietta City Schools; connects children to health care resources.
Deborah S. Heaton, RN District Director, Child Health, School Health, & Dental Health (770) 514-2339 (770) 514-2414 (fax) dsheaton@dhr.state.ga.us
Rose Bishop, RN, PHN Supervisor, Family Support Pregnancy Services (770) 514-2376 (678) 354-0751 (fax) robishop@dhr.state.ga.us
Karen Gulley Environmental Health County Manager (678) 385-5066 khgulley@dhr.state.ga.us Pat Koffman Environmental Health County Manager (770) 438-5101 plkoffma@dhr.state.ga.us
139
APPENDIX Programs & Services
Sexually Transmitted Disease
TB (Tuberculosis)
Tourist Accommodations
Trailer Parks
Universal Newborn Hearing Screening
Vital Records Services
West Nile VirusMosquito Control
Women, Infants and Children (WIC)
140
Description
Contact Information
Works to reduce morbidity associated with sexually transmitted infections, thereby preventing STIs and their complications.
Patti Duckworth, RN, DNP, APRN, BC Director, Clinical Nursing Services (770) 514-2496 (770) 514-2414 pgduckwo@dhr.state.ga.us
Identifies and treats persons who have active TB disease; finds, screens, and treats contacts; and screens high-risk populations in an effort to control transmission, prevent illness and ensure treatment of disease due to tuberculosis. Conducts design and routine inspections for over 130 tourist accommodations operated throughout the district, ensuring that minimum standards regarding construction, maintenance, and operations are met.
Phyllistine Gardner District Coordinator Tuberculosis Clinic (770) 514-2343 (770) 514-2801 (fax) pgardner@dhr.state.ga.us Karen Gulley Environmental Health County Manager (678) 385-5066 khgulley@dhr.state.ga.us
Assures a standard level of park safety and sanitation through routine inspections and enforcement actions related to garbage disposal, rodent harborage, sewage leaks, drinking water safety, and general sanitation issues. Educates medical providers and parents as to the importance of infant hearing screening and tracks children in need of follow-up hearing evaluations.
Pat Koffman Environmental Health County Manager (770) 438-5101 plkoffma@dhr.state.ga.us
Fights to prevent mosquito-borne illnesses; strives to eliminate mosquito breeding sites through education, larviciding, and complaint investigation. (Special Supplemental Nutrition Program for Women, Infants and Children) provides nutrition assessment, health screening, medical history, body measurement (weight and height), hemoglobin check, nutrition education, breast-feeding support and education, and vouchers for healthy foods.
Peter Imhoff Environmental Health Assistant Director (770) 438-5110 pvimhoff@dhr.state.ga.us Barbara Stahnke, MEd, RD, LD WIC/Nutrition Services Nutrition Services Director Cobb & Douglas Public Health 1650 County Services Parkway SW Marietta, GA 30008-4010 770-514-2453 678-350-6091 bjstahnke@dhr.state.ga.us
Laurie A. Ross, RN District Director, Birth to Five Division (770) 514-2460 (770) 514-2414 (fax) laross@dhr.state.ga.us Provides access to birth certificates for Balvina Garcia individuals born in most counties in Supervisor, Vital Records Office Georgia. Also provides access to death (770) 514-2337 certificates for individuals who died in Cobb http://www.cobbanddouglaspublichealth.o County or individuals who were a resident of rg/Programs/CertificatesAndRecords/birth. Cobb County at the time of death and died in php another county in the State of Georgia.
Acworth Public Health Center 4489 Acworth Industrial Drive Acworth, Georgia 30101 (770) 974-3330
Environmental Health Office Location 3830 South Cobb Drive, Suite 102 Smyrna, Georgia 30080 (770) 435-7815
Marietta Public Health Center 1650 County Services Parkway Marietta, Georgia 30008 (770) 514-2300
Smyrna Public Health Center
3830 South Cobb Drive, Suite 200 Smyrna, Georgia 30080 (770) 438-5105
East Cobb Public Health Center 4938 Lower Roswell Road Marietta, Georgia 30068 (678) 784-2180
South Cobb Public Health Center 875 Six Flags Drive Austell, Georgia 30168 (678) 385-1360
Lake Park
1955 Lake Park Drive, Suite 300 Smyrna, Ga. 30008-8855 (770) 432-0112
www.cobbanddouglaspublichealth.org